Evidence map›Paper›PMID 40263135›Full record

GuidelineSurgical endoscopy2025

SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how.

Richard Garfinkle, Robert D Bennett, Siva Dantu, Alessandra Gasior, Alexander T Hawkins, Jessica Holland, Ana Sofia Ore, Virginia O Shaffer, James P Taylor, Patricia Sylla and 2 more

Abstract readReviewPractice Guideline
PubMed Publisher
In one paragraph

Guideline in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Richard GarfinkleDivision of Colon and Rectal Surgery, Department of Surgery, Jewish General Hospital, McGill University, 3755 Cote Saint-Catherine Road, Montreal, QC, H3T1E2, Canada. richard.garfinkle@mail.mcgill.ca.
Robert D BennettDivision of Colon and Rectal Surgery, University of South Florida Morsani College of Medicine, Tampa Bay, FL, USA.
Siva DantuDepartment of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
Alessandra GasiorNationwide Children's Hospital, Ohio State Wexner Medical Center, Columbus, OH, USA.
Alexander T HawkinsSection of Colon and Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Jessica HollandDepartment of Surgery, Thunder Bay Regional Health Sciences Center, Thunder Bay, ON, USA.
Ana Sofia OreDepartment of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Virginia O ShafferDepartment of Surgery, University of Chicago, Chicago, IL, USA.
James P TaylorDepartment of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Patricia SyllaDepartment of Surgery, Mount Sinai Hospital, New York, NY, USA.
Elisabeth C McLemoreDepartment of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Marylise BoutrosDepartment of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHistorically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America. The purpose of this SAGES White Paper was to review the available evidence on antibiotic omission in uncomplicated diverticulitis and to explore methods of safe implementation.

methodsA task force within the SAGES Colorectal Surgery Committee was formed to work on this White Paper. The committee and its leadership approved an outline that would focus on the following topics: (1) Defining the problem with unnecessary antibiotic exposure; (2) Evaluating the evidence on antibiotic omission in uncomplicated diverticulitis; (3) Identifying the appropriate patient for antibiotic omission; (4) Outlining how to counsel patients who are treated without antibiotics; (5) Reviewing methods to safely implement this practice in both the hospital and community setting. These topics were divided up among members of the task force who performed a structured literature search in preparation for their assignments.

resultsAntibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.

conclusionThe existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.

Indexed as

Anti-Bacterial AgentsDiverticulitis, ColonicAcute DiseaseHumansAnti-Bacterial AgentsAntibioticsEvidenceSAGESUncomplicated diverticulitisWhite paper

Identifiers

PMID40263135

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.