We should not prescribe antibiotics in

the setting of non-complicated

diverticulitis
 Clinical Classification
Uncomplicated vs. Complicated
Uncomplicated Pericolic soft-tissue stranding, colonic wall thickening, phlegmon

Complicated: Acute diverticulitis + Abscess

Obstruction
Perforation
Fistula
 Danish national guidelines for treatment of
diverticular Disease
Recommendation:
Antibiotics are not routinely recommended for the treatment ofuncomplicated diverticulitis
(grade A).

Until more solid evidence is available antibiotics should still be used for the treatment of
uncomplicated diverticulitis by septicaemia,
affected general condition, pregnancy or immunosuppression
(grade C)
Jens Christian Andersen, Lars Bundgaard, Henrik Elbrnd, Sren Laurberg, Line Rosell Walker, Jens
Stvring

This guideline has been approved by the Danish Surgical Society

10.6.2011
 Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic
Diverticulitis
Caroline S. Andeweg a Irene M. Mulder b Richelle J.F. Felt-Bersma dAnnelies Verbon c Gert Jan van der Wilt h Harry van Goor g Johan F. Lange bJaap Stoker e Marja A. Boermeester f Robert P. Bleichrodt g

a Department of Surgery, St Jansdal Hospital, Harderwijk , Departments of b Surgery and c Internal Medicine, ErasmusUniversity Medical Center, Rotterdam , d Department of
Gastroenterology, VU Medical Centre, and Departments ofe Radiology and f Surgery, Academic Medical Center, Amsterdam , and Departments of g
SurgeryandEpidemiology,Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen , The Netherlands

There is no evidence that antibiotics should be routinely administered to patients with

uncomplicated diverticulitis (level 2).

Antibiotic treatment is recommended when signs of generalized infection (temperature>38.5

C) and affected general condition or signs of bacteremia or septicemia are present (level 4)

Antibiotic treatment is recommended in immunocompromised patients(level 4).

Dig Surg 2013;30:278292

DOI: 10.1159/000354035
 clinical examination alone (signs and symptoms) is insufficient to diagnose
diverticulitis.
A position statement by the Association of Coloproctology of Great Britain and
Ireland (ACPGBI) on elective resection for diverticulitis states that patients
should not be told that they have diverticulitis unless there is colonoscopic
and/or radiological evidence of inflammation in the presence of diverticular
disease
Based on history and physical examination along with laboratory
data, clinical judgment has a sensitivity of 6570% only,
Shifts in laboratory parameters may be delayed; therefore retesting after 2 days
(48-h rule) is prudent and improves safety for the benefit of the patient
 Preoperative staging of perforated diverticulitis by computed tomography
scanning
M. P. M. Gielens I. M. Mulder E. van der Harst M. P. Gosselink K. J. Kraal H. T. Teng J. F. Lange J. Vermeulen

Received: 26 December 2011 / Accepted: 11 June 2012 / Published online: 30 June 2012

In 42 % of cases, Hinchey 3 perforated diverticulitis

is falsely classified as Hinchey 1 or 2 by CT
scanning.
 Commissioning guide 2013 Colonic diverticular disease
Sponsoring Organisation: Association of Coloproctology of Great Britain and Ireland
Date of evidence search: April 2013
Date of publication: March, 2014
Date of Review: March, 2017

There is evidence that some patients with acute diverticulitis can be managed
without antibiotics. However the group felt that in a person unwell enough to be
admitted to hospital, antibiotic therapy should be initiated at least in the early
stages of treatment.
 Practice Parameters for the Treatment of Sigmoid
Diverticulitis
Daniel Feingold, M.D. Scott R. Steele, M.D. Sang Lee, M.D. Andreas Kaiser, M.DRobin Boushey, M.. W. Donald Buie, M.D. Janice Frederick Rafferty, M.D.

Diseases of the Colon & Rectum Volume 57: 3 (2014)

Prepared by the Clinical Practice Guideline Task Force of the American Society of Colon and Rectal Surgeons

Further research is required before adopting an antibiotic-free treatment

strategy
 Diverticular disease: guidelines of the german society for gastroenterology,
digestive and metabolic diseases and the german society for general and
visceral surgery. Kruis W, Germer CT, Leifeld L, , - Digestion - January 1, 2014; 90 (3); 190-207

Antibiotics are no longer recommended in

uncomplicated diverticulitis if no risk factors such as
immunosuppression are present. If close monitoring is
ensured, uncomplicated diverticulitis can be treated on
an outpatient basis.
 Practice parameters for the treatment of colonic diverticular disease:
Italian Society of Colon and Rectal Surgery (SICCR) guidelines
Techniques in Coloproctology September 2015

suggest avoiding antibiotic in acute uncomplicated diverticulitis

since may not improve short- or long-term outcomes. Use on a
case-by-case basis should possibly be considered (1B).
 American Gastroenterological Association Institute Guideline on the
Management of Acute Diverticulitis

The AGA suggests that antibiotics should be used selectively, rather than
routinely, in patients with acute uncomplicated diverticulitis.
(Conditionalrecommendation, low quality of evidence).

Areas that should be priorities for future research include the following:
Identifying patients who will benet from antibiotics and those in whom it
can safely be withheld.