Diverticulitis is a condition characterized by inflammation of the so-called diverticula. A diverticulum is a weakness in the intestinal wall. Diverticula are common in the population, especially in people over the age of 60, and are often asymptomatic. Diverticulitis can present as abdominal pain and tenderness with signs of infection, such as fever. In most cases, diverticulitis resolves without complications, however, some patients develop complications and may require emergency surgery.
Acute uncomplicated diverticulitis is the focus of this review. It has traditionally been thought of as an infection with bacterial overgrowth in the large intestine and has been treated with antibiotics. Recently, it has been argued that diverticulitis is more likely to be an inflammatory disease rather than an infectious one, making the use of antibiotics questionable. Consequently, a shift towards the use of antibiotic-free treatment regimens has been observed. This review examines whether there is clinical evidence supporting the use of antibiotics for uncomplicated diverticulitis.
Five clinical trials in hospitalized patients were evaluated. One trial looked at two different antibiotic treatments and a second study looked at the duration of intravenous antibiotic treatment. Three trials investigated the actual need for antibiotics versus no antibiotics, of which two trials had published long-term follow-up results in separate records. None of the studies found a statistical difference in the antibiotic regimens tested. The comparison between no antibiotic and antibiotic treatment did not show any differences in the occurrence of complications such as abscesses and perforations of the large intestine, or in the need for emergency surgery .
Antibiotics can cause serious side effects, including life-threatening allergic reactions or superinfections of the gut. Growing antibiotic resistance is a growing problem that makes some infections untreatable with possible fatal outcomes. There are therefore strong arguments in favor of limiting the current use of antibiotics. Only three randomized controlled trials on the need for antibiotics are currently available and more are needed to obtain strong and reliable evidence. However, the most recent evidence shows that the use of antibiotics for the treatment of acute uncomplicated diverticulitis is not superior to treatments that do not include antibiotics.