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November 14, 2021 - Diverticulitis is a condition where outpocketings along the colon's lining become inflamed. Seventy-five percent of diverticulitis cases are uncomplicated, meaning only colon wall inflammation is present. Diverticulitis is considered complicated if abscess, stricture, perforation, obstruction, or fistula are present.

For decades, the recommended treatment for diverticulitis has been antibiotics. In 2012, a study was published that compared antibiotics to observation in 623 adults with acute uncomplicated diverticulitis. The study found that antibiotics offered no benefit. Two more studies, one published in 2017 and one in 2020, also came to the same conclusion. A fourth study has just been published that randomized 480 patients who presented to the ER with acute uncomplicated diverticulitis to Augmentin for 7 days or no antibiotics (control group). Patients were discharged home from the ER, and the primary outcome was hospital admission within 90 days. At the end of the study, there was no significant difference between the antibiotic and control groups (5.8% vs 3.3%, respectively). The study was open-label, which makes the results even more convincing since the antibiotic group had the placebo effect on their side. [PubMed abstract]

The AGA 2021 treatment guidelines state that "antibiotic treatment can be used selectively, rather than routinely, in immunocompetent patients with mild uncomplicated diverticulitis." Four randomized controlled trials have now unequivocally found that antibiotics do not help uncomplicated diverticulitis. Providers should follow the evidence and forego antibiotics when treating these patients.


Diverticulitis treatment recommendations

Diverticulitis treatment regimens