Hjern F et al. (2007) Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory? Scand J Gastroenterol 42: 41–47

Antibiotic treatment for acute diverticulitis has several potential drawbacks; these include antibiotic resistance, toxicity, and changes to intestinal flora, as well as cost. To compare the outcomes of treatment with and without antibiotics, Hjern et al. conducted a retrospective analysis of 311 patients who were conservatively treated for acute diverticulitis between January 2000 and June 2002. The researchers found that antibiotics are not always necessary for the treatment of this condition.

Treatment included antibiotics for 118 patients (3 patients who did not respond also underwent surgery); for the remaining 193 patients, treatment consisted of careful observation, intravenous fluids and restriction of oral intake, to which antibiotics were added in the 7 cases of treatment failure. The decision to include or not to include antibiotics was taken by the attending surgeon. Patients treated with antibiotics were more likely to have fever at admission and higher levels of inflammatory markers than those who did not receive antibiotics; the mean hospital stay was also longer in the antibiotic-treated group. Patient-reported time to recovery did not differ between the two groups, and recurrence rates, at 28–29%, were almost identical. Regression analysis found that antibiotic treatment had no effect on risk of recurrence; the only factor associated with recurrence was a history of diverticular disease.

The results suggest that antibiotics can safely be omitted from treatment in patients with mild diverticulitis; the authors recommend prospective, randomized studies to compare antibiotic and non-antibiotic treatments for this condition.