The quality of evidence is downgraded by study limitations (lack of blinding), by imprecise results (wide confidence intervals ), and by indirectness (only radiological diagnosis included).
A Cochrane review included 3 studies with a total of 769 patients to assess the effects of antibiotic interventions for uncomplicated diverticulitis. Due to heterogeneity in interventions, no meta-analysis could be performed. All types of patients with a radiological confirmed diagnosis of uncomplicated diverticulitis were considered.
One trial investigated the effects of antibiotics versus no antibiotics and found no significant difference between the groups in abscesses or perforations (RR 2.03, 95% CI 0.51 to 8.05, 1 trial, n = 669), emergency surgery (RR 0.34, 95% CI 0.04 to 3.24) or recurrence at 12 months (RR 1.03, 95% CI 0.71 to 1.49).
Another trial compared single compound antibiotic therapy (cefoxitin) to combination therapy (gentamicin-clindamycin) with no difference in need for emergency surgery (RR 0.70, 95% CI 0.11 to 4.58, 1 trial, n = 77).
The third trial compared a short 24-48 hour IV antibiotic treatment to a longer IV treatment of 7 days followed with p.o. antibiotics for a total of 12 days. No difference was seen in selected endpoint of late stricture between the groups (RR 1.0, 95% CI 0.07 to 15.0, 1 trial, n = 50).
No data was available on symptom duration or severity.
More RCTs on the use of antibiotics versus no antibiotics is needed to confirm the safety of a no-antibiotic regime even in radiologically confirmed uncomplicated disease and to reveal the role of antibiotics in the bigger spectrum of diverticular disease.
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