Journal Review in Colorectal Surgery: Management of Acute Uncomplicated Diverticulitis With or Without Antibiotics

Sep 15, 2025

Explore the debate surrounding the use of antibiotics for managing acute uncomplicated diverticulitis. The panel discusses recent trials highlighting non-antibiotic approaches that yield similar outcomes. Delve into the clinical mindset and hesitancy in moving away from traditional treatments. The experts dissect case studies, including when to initiate antibiotics and the impact of comorbidities. Lastly, they emphasize the importance of antibiotic stewardship and strategies for implementing non-antibiotic management.

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INSIGHT

Epidemiology Explains Clinical Burden

Most diverticulosis never progresses to diverticulitis; fewer than 5% develop diverticulitis despite 70% prevalence by age 70.
Yet diverticulitis remains common in practice because diverticulosis is widespread and drives large healthcare use.

INSIGHT

Infection Assumption Drives Antibiotic Use

Clinicians assume diverticulitis is an infectious process driven by microperforation.
That assumption makes withholding antibiotics psychologically and practically difficult.

INSIGHT

When Antibiotics Actually Help

Antibiotics mainly treat systemic infection or sepsis rather than localized inflammation.
Many uncomplicated diverticulitis episodes are contained and may not need antibiotics.

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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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