Antibiotics may not reduce length of stay in patients hospitalized for uncomplicated diverticulitis

A randomized trial found that median length of hospital stay was 40.0 hours in the antibiotic group and 45.8 hours in the placebo group, with no significant between-group differences in adverse events or readmissions.

Antibiotics may not be needed in patients hospitalized for uncomplicated acute diverticulitis, a recent study found.

Researchers in New Zealand and Australia enrolled 180 patients hospitalized for uncomplicated acute diverticulitis as determined by CT. Patients were randomly assigned to seven days of placebo (n=95) or either IV cefuroxime (750 mg every 6 h) and oral metronidazole (400 mg three times a day) or oral amoxicillin/clavulanic acid (625 mg three times a day) (n=85).

The study's primary end point was length of hospital stay. Secondary end points included adverse events, readmission, procedural intervention, change in serum markers of inflammation, and patient-reported pain scores at 12 and 24 hours. Results were published online by Clinical Gastroenterology and Hepatology on March 30.

Median length of hospital stay was 40.0 hours in the antibiotic group and 45.8 hours in the placebo group (P=0.15). All but three patients completed 30 days of follow-up; one patient in the antibiotic group died of an unrelated cause, and two patients, one in each group, withdrew from the trial. Rates of readmission at one week were 6% in the placebo group versus 1% in the antibiotics group (P=0.07), while 30-day readmission rates were 6% versus 11% (P=0.30). Need for procedural intervention was 2% versus 0% (P=0.10), and overall mortality rates were 1% versus 0% (P=0.30), respectively. No difference was seen in mean reduction in white cell count (2.9 vs. 2.7; P=0.70), mean pain score at 24 hours (3.2 vs. 3.0; P=0.90), adverse event rate (12% vs. 12%; P=0.97), or serious adverse event rate (4% vs. 0%; P=0.65).

The authors concluded that placebo was noninferior to antibiotics for management of uncomplicated acute diverticulitis and said that decisions about antibiotic use in this population should be considered in the context of antibiotic resistance and stewardship. “Antibiotic use in uncomplicated acute diverticulitis has been identified as an area in which prescribing practices could change based on new evidence,” they wrote. “Given that patients with diverticular disease continue to have high antibiotic exposure in the community, this potentially represents a significant reduction in unnecessary antibiotic use.”