ArticleBMC gastroenterology2025
Outcome variation in the use and duration of antibiotic therapy in patients presenting with acute diverticulitis.
Article in BMC gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
backgroundOptimal antibiotic duration for diverticulitis managed without procedural source control is unknown. While antibiotic-sparing approaches in select patients are supported by high quality data, up to 24% experience treatment failure. Here we assess outcomes stratified by antibiotic duration in diverticulitis patients treated on an outpatient basis after an emergency department (ED) visit.
methodsEmploying the MarketScan
resultsSeventy-three thousand eight hundred ten patients were included; 54.6% were female, median age was 52 years. 11,311 (15.3%) patients did not fill an antibiotic prescription. Of those who filled one, median duration of prescription was 10.0 days. In unadjusted analysis, those who did not fill a prescription had comparable rates of surgery, but lower rates of subsequent antibiotic use (24.2% vs. 29.9%, p < 0.001) and repeat diverticulitis-related ED visits (4.9% vs. 6.0%, p < 0.001) than those with prescriptions. In an adjusted model these findings were recapitulated. Unadjusted comparisons of antibiotic duration revealed significant differences between groups. In adjusted models, durations longer than 10 days had higher odds of surgery than did shorter durations (OR = 2.20 for 11 + days vs. 7 days of duration [95% CI 1.72-2.66]).
conclusionsWe report comparable or improved outcomes in an antibiotic-sparing approach to diverticulitis. Further, longer treatment durations were not associated with reduction in recurrent disease, and were associated with higher odds of eventual surgery. These data support institutional consideration for antibiotic-sparing protocols for appropriately selected patients with diverticulitis.
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