Washington University Emergency Medicine Journal Club- July 2024
Vignette
You are halfway through an average weekday shift in EM-2 when you encounter a very pleasant 50-year-old gentleman with abdominal pain. He reports the pain began three days ago and has progressively worsened. It is a dull, moderate pain located in the left lower quadrant with no radiation. He denies fevers or chills, endorses some nausea but no vomiting. He has had some loose stools, but no hematochezia or melena. His past medical history includes hypertension, for which he takes Lisinopril. He has had no previous abdominal surgeries and has no allergies.
His vitals are: T 37.0 BP 135/80, HR 86, RR 16, SpO2 99%. His exam is remarkable for LLQ tenderness with no rebound or guarding. He is comfortable, well-appearing, and nontoxic.
Suspecting diverticulitis as the likely cause of his symptoms, you check basic labs and order a CT scan of the abdomen and pelvis with IV contrast. His WBC is 14K and his CT reveals uncomplicated sigmoid diverticulitis without perforation or abscess formation.
As you are ordering antibiotics, you remember seeing a recent article in ACEPNow suggesting that antibiotics may not actually be necessary to treat diverticulitis. You had previously scoffed at the suggestion and tossed the magazine in the trash, but now wonder if the assertion was based on real science. Aware that evidence has disproven previous dogma regarding the universal need for antibiotics in a variety of conditions (including simple abscesses and acute sinusitis), you open PubMed and begin looking up articles…
PICO Question
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Search Strategy
Article 1: Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688. Epub 2012 Jan 30. PMID: 22290281. Answer Key.
Article 2: Dichman M-L, Rosenstock SJ, Shabanzadeh DM. Antibiotics for uncomplicated diverticulitis. Cochrane Database of Systematic Reviews 2022, Issue 6. Art. No.: CD009092. DOI: 10.1002/14651858.CD009092.pub3. Answer Key.
Article 3: Mora-López L, Ruiz-Edo N, Estrada-Ferrer O, Piñana-Campón ML, Labró-Ciurans M, Escuder-Perez J, Sales-Mallafré R, Rebasa-Cladera P, Navarro-Soto S, Serra-Aracil X; DINAMO-study Group. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial. Ann Surg. 2021 Nov 1;274(5):e435-e442. doi: 10.1097/SLA.0000000000005031. PMID: 34183510. Answer Key.
Article 4: van Dijk ST, Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol. 2018 Jul;113(7):1045-1052. doi: 10.1038/s41395-018-0030-y. Epub 2018 May 11. PMID: 29700480. Answer Key.
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