Anne Peery, MD, on the Comparative Effectiveness and Harms of Antibiotics in Diverticulitis

In this video, Dr Peery discusses a study of the comparative effectiveness and harms of metronidazole-with-fluoroquinolone vs amoxicillin-clavulanate in the treatment of diverticulitis among nonhospitalized patients.

Anne Peery, MD, is an assistant professor and gastroenterologist from the Center for Gastrointestinal Biology and Disease at University of North Carolina School of Medicine in Chapel Hill, North Carolina.

TRANSCRIPT

Hello. My name is Anne Peery. I'm a gastroenterologist at the University of North Carolina in Chapel Hill. I'd like to tell you about our group's work on the comparative effectiveness and harms of antibiotics for outpatient diverticulitis. This work was published this month in the Annals of Internal Medicine.

The 2 most commonly prescribed antibiotic regimens for outpatient diverticulitis are either a combination of metronidazole and a fluoroquinolone or amoxicillin-clavulanate only. Both regimens are considered first-line, but they differ in side effects and mechanism of action. This makes for an ideal comparative effectiveness study, particularly given the growing list of harms associated with fluoroquinolone use. 

We performed two active-comparator, new-user cohort studies. The first study was in population-based claims on US residents 18 to 64. The second study was in adults ages 65 and older in Medicare. We included immunocompetent adults with diverticulitis in the outpatient setting. We compared those treated with metronidazole and a fluoroquinolone to those treated with amoxicillin-clavulanate only.

Comparing the 2 groups, we found no difference in the 1-year risk of hospital admission, the 1-year risk of emergency surgery, and the 3-year risk of elective surgery. In Medicare-only, we found that the 1-year risk of C difficile was higher in those treated with metronidazole and a fluoroquinolone compared to those treated with amoxicillin-clavulanate.

This is the first study to suggest that outpatient diverticulitis treatment with amoxicillin-clavulanate is just as effective as treatment with metronidazole and a fluoroquinolone. This is important because the risks associated with fluoroquinolone use include hypoglycemia, delirium, peripheral neuropathy, aortic dissection, aneurysms, and tendinopathies.

It's because of these risks that the US Food and Drug administration recommends fluoroquinolone use in conditions with no alternative treatment. Our study suggests that amoxicillin-clavulanate is a good alternative treatment for outpatient diverticulitis. This approach has the potential to reduce the risk of fluoroquinolone-related harms, including C difficile infection, without adversely affecting diverticulitis outcomes. 

Thanks for listening.