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Amoxicillin-Clavulanate Effective for Outpatients With Diverticulitis

TUESDAY, Feb. 23, 2021 -- For immunocompetent patients with diverticulitis in the outpatient setting, amoxicillin-clavulanate is as effective as metronidazole with fluoroquinolone, according to a study published online Feb. 23 in the Annals of Internal Medicine.

Charles E. Gaber, M.P.H., from the University of North Carolina at Chapel Hill, and colleagues examined the effectiveness and harms of metronidazole with fluoroquinolone versus amoxicillin-clavulanate for immunocompetent outpatients with diverticulitis in a nationwide population-based claims study using data for U.S. residents aged 18 to 64 years with private insurance (2000 to 2018) or those aged 65 years or older with Medicare (2006 to 2015).

A total of 106,361 new users of metronidazole with fluoroquinolone and 13,160 new users of amoxicillin-clavulanate were identified in MarketScan. The researchers observed no significant differences between the groups in one-year admission risk, one-year urgent surgery risk, three-year elective surgery risk, or one-year Clostridioides difficile infection (CDI) risk. In Medicare, 17,639 and 2,709 new users of metronidazole with fluoroquinolone and amoxicillin-clavulanate, respectively, were identified. No differences were seen between the groups in one-year admission risk, one-year urgent surgery risk, or three-year elective surgery risk. Compared with amoxicillin-clavulanate, the risk for one-year CDI was higher with metronidazole with fluoroquinolone.

"When selectively treating outpatient diverticulitis with antibiotics, physicians may consider treatment with amoxicillin-clavulanate over metronidazole-with-fluoroquinolone to reduce the risk for serious harms associated with fluoroquinolone use, including CDI," the authors write.

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Posted: February 2021

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