International Journal of Colorectal Disease

, Volume 25, Issue 11, pp 1363–1370 | Cite as

Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis

  • Yolanda RibasEmail author
  • Jordi Bombardó
  • Francesc Aguilar
  • Esther Jovell
  • Manel Alcantara-Moral
  • Francesc Campillo
  • Xavier Lleonart
  • Xavier Serra-Aracil
Original Article



Medical treatment of uncomplicated acute diverticulitis is not standardized, and there is an enormous diversity in clinical practice. Our aim was to demonstrate that uncomplicated diverticulitis can be managed with orally administered amoxicillin plus clavulanic acid and a short hospital admission.


A prospective randomized trial was established to compare patients with uncomplicated diverticulitis who received oral antibiotic after a short course of intravenous antibiotic with those who received intravenous antibiotic for a longer period. The antibiotic treatment consisted of amoxicillin plus clavulanic acid 1 g every 8 h. We included 50 patients, 25 in each group. Patients in group 1 began oral antibiotic as soon as they improved and were discharged the day after. Patients in group 2 received intravenous antibiotic for 7 days. Both groups received oral antibiotic at discharge. The endpoint of the study was “failure of treatment,” which was defined as the impossibility of discharging on the expected day, emergency admission, or hospital readmission.


Both groups were comparable in patient demographics and clinical characteristics. Most patients clearly improved between 24 and 48 h after admission. There were no significant differences between the groups when comparing failure of treatment. Treatment of patients in group 1 represented a savings in hospitalization costs of 1,244€ per patient.


Most patients with uncomplicated diverticulitis can be managed safely with oral antibiotic; thus, a very short hospital stay is a safe option.


Acute diverticulitis Medical treatment Antibiotic Amoxicillin plus clavulanic acid 


Conflict of interest



  1. 1.
    Rodkey GV, Welch CE (1965) Diverticulitis of the colon: evolution in concept and therapy. Surg Clin N Am 45:1231–1243PubMedGoogle Scholar
  2. 2.
    Painter NS, Burkitt DP (1971) Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ 2:450–454CrossRefPubMedGoogle Scholar
  3. 3.
    Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMedGoogle Scholar
  4. 4.
    Ambrosetti P, Robert JH, Witzig JA, Mirescu D, Mathey P, Borst F et al (1994) Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases. Surgery 115:546–550PubMedGoogle Scholar
  5. 5.
    Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMedGoogle Scholar
  6. 6.
    Almy TP, Howell DA (1980) Diverticular disease of the colon. N Engl J Med 302:324–331CrossRefPubMedGoogle Scholar
  7. 7.
    Young-Fadok TM, Roberts PL, Spencer MP, Wolff BG (2000) Colonic diverticular disease. Curr Probl Surg 37:457–514CrossRefPubMedGoogle Scholar
  8. 8.
    Burkitt DP, Walker ARP, Painter NS (1974) Dietary fiber and disease. JAMA 229:1068–1074CrossRefPubMedGoogle Scholar
  9. 9.
    Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A et al (2003) Diverticular disease of the colon on the rise: study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 17:1189–1195CrossRefPubMedGoogle Scholar
  10. 10.
    Salem L, Anaya DA, Flum DR (2005) Temporal changes in the management of diverticulitis. J Surg Res 124:318–323CrossRefPubMedGoogle Scholar
  11. 11.
    Drusano GL, Warren JW, Saah AJ, Caplan ES, Tenney JH, Hansen S et al (1982) A prospective randomized controlled trial of cefoxitin versus clindamycin–aminoglycoside in mixed anaerobic–aerobic infections. Surg Gynecol Obstet 154:715–720PubMedGoogle Scholar
  12. 12.
    Danzinger LH, Creger RJ, Shwed JA, Stellato TA, Hau T (1988) Randomized trial of imipenem–cilastatin versus gentamicin plus clindamycin in the treatment of polymicrobial infections. Pharmacotherapy 8:315–318Google Scholar
  13. 13.
    Kellum JM, Sugerman HJ, Coppa GF, Way LR, Fine R, Herz B et al (1992) Randomized, prospective comparison of cefoxitin and gentamicin–clindamycin in the treatment of acute colonic diverticulitis. Clin Ther 14:376–384PubMedGoogle Scholar
  14. 14.
    Investigators of the Piperacillin/Tazobactam Intra-abdominal Infection Study Group (1994) Results of the North American trial of piperacillin/tazobactam compared with clindamycin and gentamicin in the treatment of severe intra-abdominal infections. Eur J Surg Suppl 573:61–66Google Scholar
  15. 15.
    Patel SM, Saravolatz LD (2006) Monotherapy vs combination therapy. Med Clin N Am 90:1183–1195CrossRefPubMedGoogle Scholar
  16. 16.
    Roberts P, Abel M, Rosen L, Cirocco W, Fleshman J, Leff E et al (1995) Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 38:125–132CrossRefPubMedGoogle Scholar
  17. 17.
    Wong WD, Wexner SD, Lowry A, Vernava A 3rd, Burnstein M, Dentsman F et al (2000) Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43:290–297CrossRefPubMedGoogle Scholar
  18. 18.
    Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944CrossRefPubMedGoogle Scholar
  19. 19.
    Stollman NH, Raskin JB (1999) Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 94:3110–3121CrossRefPubMedGoogle Scholar
  20. 20.
    Sheth AA, Longo W, Floch MH (2008) Diverticular disease and diverticulitis. Am J Gastroenterol 103:1550–1556CrossRefPubMedGoogle Scholar
  21. 21.
    Elebute A, Stoner HB (1983) The grading of sepsis. Br J Surg 70:29–31CrossRefPubMedGoogle Scholar
  22. 22.
    Schechter S, Mulvey J, Eisenstat TE (1999) Management of uncomplicated acute diverticulitis. Results of a survey. Dis Colon Rectum 42:470–476CrossRefPubMedGoogle Scholar
  23. 23.
    Munikrishnan V, Helmy A, Elkhider H, Omer AA (2006) Management of acute diverticulitis in the East Anglian region: results of a United Kingdom regional survey. Dis Colon Rectum 49:1332–1340CrossRefPubMedGoogle Scholar
  24. 24.
    Mizuki A, Nagata H, Tatemichi M, Kanedas S, Tsukada N, Ishii H et al (2005) The outpatient management of patients with acute mild-to-moderate colonic diverticulitis. Aliment Pharmacol Ther 21:889–897CrossRefPubMedGoogle Scholar
  25. 25.
    Martín Gil J, Serralta De Colsa D, Garcia Martin A, Vaquero Rodríguez A, Rey Valcárcel C, Pérez Diaz MD et al (2009) Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda. Gastroenterol Hepatol 32:83–87CrossRefPubMedGoogle Scholar
  26. 26.
    Alonso S, Pera M, Parés D, Pascual M, Gil MJ, Courtier R, et al. (2010) Outpatient treatment of patients with uncomplicated acute diverticulitis. Colorectal Dis. doi: 10.1111/j.1463-1318.2009.02122.x
  27. 27.
    Ridgway PF, Latif A, Shabbir J, Ofriokuma F, Hurley MJ, Evoy D et al (2009) Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis. Colorectal Dis 11:941–946CrossRefPubMedGoogle Scholar
  28. 28.
    McKnee RF, Deignan RW, Krukowski ZH (1993) Radiological investigation in acute diverticulitis. Br J Surg 80:560–565CrossRefGoogle Scholar
  29. 29.
    Hachigan MP, Honickman S, Eisentat TE, Rubin RJ, Salvati EP (1992) Computed tomography in the initial management of acute left-sided diverticulitis. Dis Colon Rectum 35:1123–1129CrossRefGoogle Scholar
  30. 30.
    Jacobs DO (2007) Diverticulitis. N Engl J Med 357:2057–2066CrossRefPubMedGoogle Scholar
  31. 31.
    Brengman ML, Otchy DP (1998) Timing of computed tomography in acute diverticulitis. Dis Colon Rectum 41:1023–1028CrossRefPubMedGoogle Scholar
  32. 32.
    Al-Sahaf O, Al-Azawi D, Fauzi MZ, El-Masry S, Gillen P (2008) Early discharge policy of patients with acute diverticulitis following initial CT scan. Int J Colorectal Dis 23:817–820CrossRefPubMedGoogle Scholar
  33. 33.
    Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338:1521–1526CrossRefPubMedGoogle Scholar
  34. 34.
    Zarling EJ, Piontek F, Klemla-Walden L, Inczauskis D (1997) The effect of gastroenterology training on the efficiency and cost of care provided to patients with diverticulitis. Gastroenterology 112:1859–1862CrossRefPubMedGoogle Scholar
  35. 35.
    Painter NS (1982) Diverticular disease of the colon. The first of the Western diseases shown to be due to deficiency of dietary fiber. S Afr Med J 61:1016–1020PubMedGoogle Scholar
  36. 36.
    Aldoori WH, Giovannucci EL, Rimm EB, Trichopoulos DV, Willett WC (1994) A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 60:757–764PubMedGoogle Scholar
  37. 37.
    Hyland JM, Taylor I (1980) Does a high fiber diet prevent the complications of diverticular disease? Br J Surg 67:77–79CrossRefPubMedGoogle Scholar
  38. 38.
    Korzenik JR (2006) Case closed? Diverticulitis: epidemiology and fiber. J Clin Gastroenterol 40(supp 3):S112–S116CrossRefPubMedGoogle Scholar
  39. 39.
    Ornstein MH, Littlewood ER, Baird IM, Fowler J, North WR, Cox AG (1981) Are fiber supplements really necessary in diverticular disease of the colon? A controlled clinical trial. BMJ 282:1353–1356CrossRefPubMedGoogle Scholar
  40. 40.
    Janes SEJ, Meagher A, Frizelle FA (2006) Management of diverticulitis. BMJ 332:271–275CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Yolanda Ribas
    • 1
    Email author
  • Jordi Bombardó
    • 2
  • Francesc Aguilar
    • 1
  • Esther Jovell
    • 3
  • Manel Alcantara-Moral
    • 2
  • Francesc Campillo
    • 1
  • Xavier Lleonart
    • 1
  • Xavier Serra-Aracil
    • 2
  1. 1.Department of SurgeryConsorci Sanitari de TerrassaTerrassaSpain
  2. 2.Department of SurgeryCorporació Sanitària Parc TaulíSabadellSpain
  3. 3.EpidemiologyConsorci Sanitari de TerrassaTerrassaSpain

Personalised recommendations