Clinical question: Can clinicians successfully manage mild acute diverticulitis on an outpatient basis without antibiotics?
Background: Incidence of diverticular disease is increasing, with as many as 25% of patients with diverticulosis suffering an episode of acute diverticulitis in their lifetime; 75% of these cases present without complications. Previous evaluation has shown that patients with mild acute diverticulitis can achieve good outcomes with conservative management.
Study design: Randomized, controlled, noninferiority trial
Setting: 15 hospitals throughout Spain
Synopsis: 480 patients with mild acute diverticulitis as defined by stable clinical status, no significant comorbidities, and a Neff 0 acute diverticulitis on CT scan (local swelling of the colon without evidence of perforation or abscess) were randomized in the emergency department after achieving successful symptom control. Patients in the experimental arm were discharged with symptomatic control consisting of ibuprofen 600 mg alternating with acetaminophen 1 g every eight hours for seven days. Patients in the control group were discharged with a seven-day course of amoxicillin/clavulanic acid 875mg/125 mg. There was no statistically significant difference in the antibiotic versus non-antibiotic groups in ED revisits (16/236 [6.72%] versus 14/238 [7.02%]), hospitalization (14/238 [5.8%] versus 8/242 [3.3%]) or pain control at 90 days. None of the patients who were readmitted in either group required emergent surgical intervention.
Bottom line: Mild acute diverticulitis treated outside the hospital without antibiotics is a safe and effective strategy that does not lead to increased emergency department visits, hospitalizations, or complication rates when compared to outpatient management with antibiotics.
Citation: Mora-López L, et al. Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO-study): a multicentre, randomized, open-label, noninferiority trial. Ann Surg. 2021;274(5):e435-e442. doi: 10.1097/SLA.0000000000005031. PMID: 34183510.
Dr. Scaletta is a hospitalist at Denver Health, Denver, and an assistant professor in the division of internal medicine, at the University of Colorado School of Medicine.