Individual research recommendation details

Recommendation ID

NG147/1

Question

What is the clinical and cost effectiveness of antibiotics for the management of acute diverticulitis in primary care?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
For people with suspected acute diverticulitis who are not referred for urgent same-day hospital assessment, the committee agreed that watchful waiting is an option if the person is systemically well and has no comorbidities that increase the risk of infection. This decision would be in the context of shared decision making. Simple analgesia and advice can be offered. Oral antibiotics are appropriate if the person is systemically unwell but does not meet the criteria for referral with suspected complicated acute diverticulitis.

The evidence supports current practice of treating an acute episode of diverticulitis with intravenous antibiotics in secondary care. If CT confirms uncomplicated acute diverticulitis, switching to oral antibiotics does not affect outcomes. The committee recommended antibiotics for this group because they were aware of evidence that watchful waiting could increase recurrence rates and the probability of further surgery. In support of antibiotic stewardship and to avoid antibiotic resistance the committee recommended that the person should be reassessed if necessary and the need for antibiotic treatment should be reviewed.

The need for intravenous antibiotics should be reviewed, including whether to stop them, within 48 hours in line with current good practice on antibiotic prescribing or after the CT scan. The CT will confirm if the person has an abscess or not. The total course of antibiotic treatment should be for a maximum of 5 days and then reviewed. The duration may need to be longer in people with diverticular abscess. The duration of antibiotics used in the studies was variable and 5 days was based on current clinical practice and the knowledge and expertise of the committee.

In light of the lack of evidence on this topic, and the need to prevent antibiotic resistance, the committee considered this an important area for research. It made a research recommendation on antibiotics for people with acute diverticulitis managed in primary care.

How the recommendations might affect practice
The recommendation to offer an initial treatment of intravenous antibiotics before CT scanning for confirmation reflects current practice, so there should be no change in practice. Using oral antibiotics beyond this point in place of intravenous antibiotics may reduce the resource requirement in caring for people with acute diverticulitis.

Full details of the evidence and the committee's discussion are in evidence review H: non-surgical management of acute diverticulitis.

Source guidance details

Comes from guidance

Diverticular disease: diagnosis and management

Number

NG147

Date issued

November 2019

Other details