Amoxicillin-Clavulanate Favored Over Fluoroquinolone-Metronidazole for Outpatient Diverticulitis

Colorectal

Douglas K. Rex, MD, MASGE reviewing Gaber CE, et al. Ann Intern Med 2021 Jun.

A combination of fluoroquinolone (ciprofloxacin, levofloxacin) and metronidazole is the most commonly used antibiotic treatment for outpatient diverticulitis. However, the U.S. Food and Drug Administration has warned that fluoroquinolones are associated with hypoglycemia, aortic dissection, aneurysm, tendon and muscle injury, peripheral neuropathy, and adverse mental health effects.

The authors evaluated 2 nationwide cohorts for retrospective information on outcomes of fluoroquinolone-metronidazole versus amoxicillin-clavulanate treatment.

In the 2 cohorts, the use of fluoroquinolone-metronidazole was 8 to 9 times more common than the use of amoxicillin-clavulanate. In both cohorts, the 1-year risk of hospitalization and the 3-year risk of elective surgery were similar between the antibiotic regimens. In the Medicare cohort, there was a higher risk of C difficile infection associated with the use of fluoroquinolone-metronidazole (1.2%) than with amoxicillin-clavulanate (0.6%).

Comment:

Findings from recent randomized controlled trials suggest that antibiotics have no significant benefit for uncomplicated diverticulitis. Given the recent warnings about fluoroquinolones and the absence of differences favoring fluoroquinolone-metronidazole, the authors recommend prescribing amoxicillin-clavulanate more commonly for outpatient diverticulitis when antibiotics are used.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Gaber CE, Kinlaw AC, Edwards JK, et al. Comparative effectiveness and harms of antibiotics for outpatient diverticulitis: two nationwide cohort studies. Ann Intern Med 2021;174:737-746. (https://doi.org/10.7326/m20-6315)