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Reviewers question the use of antibiotics for uncomplicated diverticulitis

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7825 (Published 20 November 2012) Cite this as: BMJ 2012;345:e7825

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Antibiotics are a standard treatment for uncomplicated diverticulitis, recommended by guidelines. A careful search for supporting evidence found just three randomised trials. Only one—the best and most recent—compared antibiotics with no antibiotics in a big sample of adults. The antibiotics made no difference to complications, length of stay, need for surgery, or recurrence. Two smaller trials compared different drugs or different durations of treatment, and it found no clinically useful differences between treatment groups.

Uncomplicated diverticulitis is common, say the authors. Patients are given antibiotics because of presumed infection with Escherichia coli and other microbes. Doctors hope treatment will prevent progression to something more serious, such as abscess formation, perforation, or fistulas. They hope to stop the condition bouncing back, which it often does. This preliminary review isn’t conclusive enough to change well established practice, but it does suggest that antibiotics may not work as well as we think they should.

High quality trials are now needed to find out whether antibiotics are really necessary for these patients, say the authors. Antibiotics can cause life threatening superinfection with Clostridium difficile, and unnecessary use fuels the spread of antibiotic resistance through populations. One more trial is currently under way and due to report in 2014.

Notes

Cite this as: BMJ 2012;345:e7825