SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how
- 22.04.2025
- SAGES/EAES official publication
Erschienen in:
- Verfasst von
- Richard Garfinkle
- Robert D. Bennett
- Siva Dantu
- Alessandra Gasior
- Alexander T. Hawkins
- Jessica Holland
- Ana Sofia Ore
- Virginia O. Shaffer
- James P. Taylor
- Patricia Sylla
- Elisabeth C. McLemore
- Marylise Boutros
- Erschienen in
- Surgical Endoscopy | Ausgabe 6/2025
Abstract
Background
Historically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America. The purpose of this SAGES White Paper was to review the available evidence on antibiotic omission in uncomplicated diverticulitis and to explore methods of safe implementation.
Methods
A task force within the SAGES Colorectal Surgery Committee was formed to work on this White Paper. The committee and its leadership approved an outline that would focus on the following topics: (1) Defining the problem with unnecessary antibiotic exposure; (2) Evaluating the evidence on antibiotic omission in uncomplicated diverticulitis; (3) Identifying the appropriate patient for antibiotic omission; (4) Outlining how to counsel patients who are treated without antibiotics; (5) Reviewing methods to safely implement this practice in both the hospital and community setting. These topics were divided up among members of the task force who performed a structured literature search in preparation for their assignments.
Results
Antibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.
Conclusion
The existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.
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- Titel
- SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how
- Verfasst von
-
Richard Garfinkle
Robert D. Bennett
Siva Dantu
Alessandra Gasior
Alexander T. Hawkins
Jessica Holland
Ana Sofia Ore
Virginia O. Shaffer
James P. Taylor
Patricia Sylla
Elisabeth C. McLemore
Marylise Boutros
- Publikationsdatum
- 22.04.2025
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 6/2025
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-025-11738-w
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