Antibiotics in Uncomplicated Diverticulitis: Are we Aligning With the Evidence? A Retrospective Two-Centre Study

Colonic diverticulitis is a common diagnosis at emergency presentation, and traditional management includes admission, bowel rest and intravenous antibiotics. We investigated the management of patients who presented to two centres over a 2-year period with acute uncomplicated diverticulitis (AUD) in the context of evidence and recent guidelines suggesting that select patients can be managed safely in the outpatient setting and without antibiotics.

Data was collected for all patients who presented to two metropolitan emergency departments from January 2023 to December 2024 with AUD. Each case was then assessed against predetermined criteria for admission, based on recent guidelines and randomised controlled trials. The primary outcome was use of antibiotics in those eligible for management without them. Secondary outcomes included IV antibiotic use and reasons for admission.

A total of 564 patients across the two centres were included. 229 patients were deemed eligible for nonantibiotic therapy +/- discharge. 130 of these patients were admitted; all received antibiotics. Only eight of 229 did not receive antibiotics. Outside of these 130 patients admitted without clear indication, the most common reasons for admission were sepsis, failure of outpatient therapy and age.

Most eligible patients with AUD still receive antibiotics, in both inpatient and outpatient settings, which highlights a major discrepancy between evidence-based guidelines and real-world practice.