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.
BACKGROUND
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.


METHODS
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.


RESULTS
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<euro> per patient.


CONCLUSIONS
Most patients with uncomplicated diverticulitis can be managed safely with oral antibiotic; thus, a very short hospital stay is a safe option.
Department of Surgery, Consorci Sanitari de Terrassa, Carretera de Torrebonica s/n, Terrassa, Spain. ribas.yolanda@gmail.com
Yolanda
Y
Ribas
Jordi
J
Bombardó
Francesc
F
Aguilar
Esther
E
Jovell
Manel
M
Alcantara-Moral
Francesc
F
Campillo
Xavier
X
Lleonart
Xavier
X
Serra-Aracil
D000208:Acute Disease; D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000008:administration & dosage* / Q000627:therapeutic use*; D003710:Demography; D004238:Diverticulitis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D000658:Amoxicillin