Antibiotic prescribing remains high for uncomplicated diverticulitis 

1. In this study, antibiotics were prescribed in nearly all visits for uncomplicated diverticulitis between 2015 and 2025, despite guideline recommendations discouraging routine antibiotic use.

2. Fluoroquinolone-based regimens and amoxicillin-clavulanate were the most commonly prescribed antibiotics, with prescribing patterns shifting toward amoxicillin-clavulanate over time.

Evidence Rating Level: 2 (Good)

Study Rundown: Routine antibiotic use for uncomplicated diverticulitis has been associated with more harm than benefit, and since 2015, clinical guidelines have recommended selective rather than routine antibiotic prescribing. This study examined antibiotic prescribing patterns for uncomplicated diverticulitis in emergency department and urgent care settings between 2015 and 2025. More than 33,000 visits for uncomplicated diverticulitis were included. Despite guideline recommendations, antibiotics were prescribed in the vast majority of visits throughout the study period, with prescribing rates remaining consistently high over the 10-year follow-up. Similar patterns were observed across individual facilities. The most commonly prescribed regimens were fluoroquinolone-based therapies and amoxicillin-clavulanate. Over time, prescribing practices shifted away from fluoroquinolone-based regimens toward amoxicillin-clavulanate, reflecting evolving concerns regarding fluoroquinolone safety. However, this change did not translate into a substantial reduction in overall antibiotic use. The study’s findings should be interpreted in light of several limitations, including the potential for misclassification of uncomplicated diverticulitis and inaccuracies in prescription records. Nevertheless, the results suggest that routine antibiotic prescribing for uncomplicated diverticulitis remains widespread in emergency and urgent care settings despite a decade of guideline recommendations discouraging this practice. These findings highlight an ongoing need for interventions that promote selective antibiotic use and strengthen antibiotic stewardship efforts.

Click to read this study in AIM

Relevant Reading: American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis

In-Depth [retrospective cohort]: This retrospective cohort study examined temporal trends in antibiotic prescribing for uncomplicated diverticulitis in US Department of Veterans Affairs (VA) emergency departments and urgent care clinics between October 2015 and June 2025. Visits were eligible if they were coded as uncomplicated diverticulitis and conducted by a physician or advanced practice clinician. Multiple exclusion criteria were applied to remove patients with recent diverticulitis, prior antibiotic exposure, immunocompromising conditions, hospitalization, or other indications for antibiotic treatment. The primary outcome was antibiotic prescribing, defined as an antibiotic ordered on the same day as the visit or the following day. Secondary outcomes included the type of antibiotic prescribed. A total of 33,634 visits involving 28,474 unique patients were analyzed across 120 VA facilities. Annual visit volumes remained relatively stable throughout the study period. Overall, antibiotics were prescribed in 96.6% of visits (n = 32,497). After adjustment, the annual prevalence of antibiotic prescribing consistently exceeded 95% throughout the 10-year study period, indicating little change despite guideline recommendations favoring selective antibiotic use. Among facilities with at least 30 visits, the median proportion of visits resulting in an antibiotic prescription was 97%. The most commonly prescribed regimens were fluoroquinolone-based therapies (45.6%) and amoxicillin-clavulanate (42.7%). Although overall prescribing rates remained high, prescribing patterns shifted over time, with fluoroquinolone-based regimens predominating in 2015 and amoxicillin-clavulanate becoming the most common regimen by 2025. This change likely reflects increasing concerns regarding fluoroquinolone-associated adverse effects and evolving prescribing practices. A review of visits without electronically captured antibiotic orders suggested that some antibiotic prescriptions may not have been fully recorded in the electronic health record, indicating that actual prescribing rates may have been even higher than reported. Overall, this study suggests that routine antibiotic prescribing for uncomplicated diverticulitis remains widespread in emergency and urgent care settings, despite a decade of guideline recommendations discouraging routine antibiotic use. These findings highlight an ongoing need for interventions that promote selective prescribing and strengthen antibiotic stewardship efforts.

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