Guest posting : Dr Daniel Isacson, local GP (ex Swedish researcher)

The evidence is out and there is no proven benefit in recovery or complication rates in treating these patients with or without antibiotics, but still many GPs and surgeons prefer to use antibiotics. How do we get the word across? 

Diverticulitis has become one of the most burdensome pathologies to the health care system, ranking as the sixth most important gastrointestinal disease worldwide. Diverticular disease affects about one-third over the age of 45 and two-thirds over the age of 85 . Most patients are asymptomatic with 1-4%  developing symptomatic diverticulitis.

Two randomized trials (below),  one population-based study as well as a case-control study have shown no benefit of antibiotic therapy in acute uncomplicated diverticulitis, with reported complication rates of approximately 2%.   It is suggested that the pathogenesis most likely relates to non-infective  inflammation rather than an infectious cause.

Therapeutic Guidelines (Australia) and the World Health Organisation currently recommend outpatient non-antibiotic management for patients with uncomplicated diverticulitis presenting with mild to moderate abdominal pain, low grade fever, minimal rise of inflammatory markers, provided they can tolerate clear fluids, have minimal comorbidities, good compliance and a good support system.

References available upon request.  The two RCTs are:

•  Isacson D, Thorisson A,  Andreasson K, Nikberg M, Smedh K, Chabok A. Outpatient non-antibiotic management of acute uncomplicated diverticulitis: a prospective study. International journal of colorectal disease. 2015 Sep;30(9):1229-34
• Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K, Group AS. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. The British journal of surgery. 2012 Apr;99(4):532-9.

Image credit: Wikipedia : extensive diverticulosis of the sigmoid colon.