Antibiotics are routinely used in the management of uncomplicated acute diverticulitis, a practice based on low-level evidence. In the past 10 years, as there's been a trend toward more conservative management of uncomplicated acute diverticulitis, researchers have raised questions about the need for antibiotics. In a randomized, double-blind, placebo-controlled clinical trial, researchers compared standard antibiotic treatment with placebo in patients with uncomplicated acute diverticulitis determined by computed tomography.

A total of 180 participants were randomized to antibiotics or placebo. Demographic and clinical characteristics of the two groups were similar. Participants completed a symptom questionnaire every 12 hours for the first 48 hours and then daily until discharge.

There was no statistically significant difference in length of hospital stay, the primary outcome, in the placebo group compared with the antibiotics group (45.8 versus 40 hours, respectively). There were also no statistically significant differences in the secondary outcomes of one week and 30-day readmissions, the need for procedural intervention, mortality, mean reduction of white cell count, or mean pain score. Differences in treatment discontinuation, study withdrawal rates, and adverse event rates were also not statistically significant between the two groups.

The sample size of the study may not have been adequate to detect differences in outcomes other than the length of hospital stay. Additionally, the authors note that the study's 30-day follow-up after discharge may have led them to miss longer-term outcomes. They observe that this study adds to a growing body of evidence suggesting that selective antibiotic treatment for uncomplicated acute diverticulitis should be incorporated into clinical protocols.