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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, April 18, 2023

ATBs in diverticulitis

First10EM - By Justin Morgenstern - April 17, 2023
Bottom line
It is now very clear that uncomplicated diverticulitis does not require antibiotic therapy. It is time to change practice. 
In my mind, the easiest way to change practice for most patients is to stop before you even make the diagnosis of diverticulitis. If the only reason you are ordering CT is to look for diverticulitis, just skip the CT (for now at least). Give the patient a few days of symptomatic management before irradiating them, because that is probably the correct approach whether the CT is positive or negative for diverticulitis. 
If you do have CT proven diverticulitis, it is clear that the vast majority of patients don’t need antibiotics, but clinical judgment is still important. I am not rushing to apply this evidence to immunosuppressed cancer patients. Finally, shared decision making is always essential in medicine. Reducing unnecessary antibiotic usage is important, but the harms of a single prescription are pretty low. Talk to your patients and help them make the best decision. If they really want antibiotics, consider a delayed prescription to be used only if they aren’t improving in three days time.