Case: Small Abscess and Comorbidities — Treat or Observe?

Why are we still treating acute uncomplicated diverticulitis with antibiotics? There is plenty of evidence from several randomized controlled trials demonstrating that symptomatic management alone yields similar results. If we should continue prescribing antibiotics for acute uncomplicated diverticulitis, which patients should undergo treatment and when? Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss the management of uncomplicated diverticulitis while reviewing groundbreaking literature.

Hosts:
-Jared Hendren, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Elissa Dabaghi, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Joseph Trunzo, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter @joseph_trunzo
- Ajaratu Keshinro, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter- @AJKesh
- David Rosen, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter- @davidrrosenmd

Learning Objectives: By the end of this episode, listeners will be able to:
1.     Identify criteria for managing acute uncomplicated diverticulitis without antibiotics based on recent literature
2.     Define uncomplicated and complicated diverticulitis
3.     Discuss nuanced management decisions of patients with uncomplicated diverticulitis to determine when antibiotics may be appropriate for management

References:
1.     Azhar, N., Aref, H., Brorsson, A., Lydrup, M.‑L., Jörgren, F., Schultz, J. K., & Buchwald, P. (2022). Management of acute uncomplicated diverticulitis without antibiotics: Compliance and outcomes – a retrospective cohort study. BMC Emergency Medicine, 22(1), Article 28. https://doi.org/10.1186/s12873‑022‑00584‑X 
2.     Mora‑López, L., Ruiz‑Edo, N., Estrada‑Ferrer, O., Piñana‑Campón, M. L.,
Labró‑Ciurans, M., Escuder‑Perez, J., Sales‑Mallafré, R., Rebasa‑Cladera, P.,
Navarro‑Soto, S., Serra‑Aracil, X., & DINAMO‑study Group. (2021). Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO‑study): A multicentre, randomised, open‑label, noninferiority trial. Annals of Surgery, 274(5), e435–e442. https://doi.org/10.1097/SLA.0000000000005031
3.     Daniels, L., Ünlü, Ç., de Korte, N., van Dieren, S., Stockmann, H. B., Vrouenraets, B. C., Consten, E. C., van der Hoeven, J. A., Eijsbouts, Q. A., Faneyte, I. F., Bemelman, W. A., Dijkgraaf, M. G., & Boermeester, M. A. (2017). Randomized clinical trial of
observational versus antibiotic treatment for a first episode of CT‑proven uncomplicated acute diverticulitis. British Journal of Surgery, 104(1), 52‑61. https://doi.org/10.1002/bjs.10309
4.     Chabok, A., Påhlman, L., Hjern, F., Haapaniemi, S., & Smedh, K.; AVOD Study Group. (2012). Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery, 99(4), 532–539. https://doi.org/10.1002/bjs.8688

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