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Antibiotic Discretion in the Treatment of Acute Uncomplicated DiverticulitisA Teachable Moment

Educational Objective
To review the evidence for discretionary, rather than routine, use of antibiotics in acute uncomplicated diverticulitis.
1 Credit CME

A marginally housed man in his 50s with a history of alcohol use disorder and essential hypertension presented to the emergency department with abdominal pain for 2 days. On presentation, his vitals were within normal limits. His abdomen was soft, nondistended, and tender in the left lower quadrant with voluntary guarding but no rebound tenderness. He reported his pain as a 6 on a 10-point scale. Laboratory results revealed a white blood cell count of 9.9 × 109/L, liver function test results were within normal limits, a serum creatinine of 0.68 mg/dL (to convert to μmol/L, multiply by 88.4), and a lipase of 29 U/L (to convert to μkat/L, multiply by 0.0167). Urinalysis results were within normal limits. Computed tomographic (CT) imaging of his abdomen demonstrated bowel wall thickening of a sigmoid diverticulum without perforation, consistent with acute uncomplicated diverticulitis. The patient was given ertapenem in the emergency department and discharged with a 10-day course of amoxicillin-clavulanate.

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Article Information

Corresponding Author: Bharat Maraj, MD, Department of Internal Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (bharat.maraj@ucsf.edu).

Published Online: July 30, 2018. doi:10.1001/jamainternmed.2018.3507

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
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2.
Chabok  A, Påhlman  L, Hjern  F, Haapaniemi  S, Smedh  K; AVOD Study Group.  Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis.  Br J Surg. 2012;99(4):532-539. doi:10.1002/bjs.8688PubMedGoogle ScholarCrossref
3.
Daniels  L, Ünlü  Ç, de Korte  N,  et al; Dutch Diverticular Disease (3D) Collaborative Study Group.  Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis.  Br J Surg. 2017;104(1):52-61. doi:10.1002/bjs.10309PubMedGoogle ScholarCrossref
4.
Isacson  D, Andreasson  K, Nikberg  M, Smedh  K, Chabok  A.  Outpatient management of acute uncomplicated diverticulitis results in health-care cost savings.  Scand J Gastroenterol. 2018;53(4):449-452. doi:10.1080/00365521.2018.1448887PubMedGoogle ScholarCrossref
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Thorisson  A, Smedh  K, Torkzad  MR, Påhlman  L, Chabok  A.  CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis.  Int J Colorectal Dis. 2016;31(2):451-457. doi:10.1007/s00384-015-2423-3PubMedGoogle ScholarCrossref
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