Written by Clay Smith
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Amoxicillin-clavulanate (AC) compared to fluoroquinolone + metronidazole (FM) was not associated with worsened outcomes for outpatient treatment of diverticulitis and may reduce known harm related to the fluoroquinolone class of antibiotic.
Why does this matter?
There is some evidence that in select cases, antibiotics could be avoided for diverticulitis, though I remain skeptical. Usually, FM is prescribed for outpatient treatment of diverticulitis. Yet fluoroquinolones are associated with tendon rupture, hypoglycemia, altered mental status, possibly aortic dissection, QT prolongation, and possibly sudden death.
How to fix the tics
This was a retrospective study of a national claims database comparing FM to AC for outpatient treatment of uncomplicated diverticulitis. FM was used 82% of the time. There was no difference in hospital admission at one year, need for urgent surgery at one year, or risk of C. difficile colitis. In Medicare recipients (generally ≥65 years), the risk of C. difficile was slightly greater in the FM cohort, but the other outcomes were the same. I think this is a practice-changer for me.
Source
Comparative Effectiveness and Harms of Antibiotics for Outpatient Diverticulitis : Two Nationwide Cohort Studies. Ann Intern Med. 2021 Feb 23. doi: 10.7326/M20-6315. Online ahead of print.
Since the vast majority of patients with diverticulitis (85-90%) get better without any antibiotics at all (at least 2 RCTs that I know of plus multiple observational studies) it’s not hard to imagine that antibiotic A would seem just as effective as antibiotic B..