Treatment of diverticulitis with fluoroquinolones-bound amoxicillin-clavulanate spike bath

Treatment of diverticulitis of patients with amoxicillin-clavulanate was “just as effective” as treatment with a combination of metronidazole and fluoroquinolone, a researcher told Healio Primary Care.

Data show that treatment with amoxicillin-clavulanate does not carry the same risks for adverse events associated with fluoroquinolones.

According to researchers, acute diverticulitis accounts for $ 5.5 billion in health care costs each year. The situation is common – 209 cases per 100,000 years in the United States.

“The two most common antibiotic regimens for outpatient diverticulitis are a combination of metronidazole and fluoroquinolone or amoxicillin-clavulanate alone,” he said. Anne Peery, MD, MSCR, assistant professor of medicine in the department of gastroenterology and hepatology at the University of North Carolina School of Medicine.

“Although the two regimes are considered first-line treatment, they differ in their methods of action and side effects,” she said. “This is the appropriate comparative efficacy study, particularly with the growing list of harms associated with fluoroquinolone use. ”

Peery and colleagues compared the efficacy and harm of the treatments in two groups of patients with acute diverticulitis. The first included U.S. residents between the ages of 18 and 64 in the IBM MarketScan Commercial Applications and Encounters Database (n = 119,521), and the second included Medicare patients aged 65 years or over. older between 2006 and 2015 (n = 20,348).

The researchers, in the MarketScan group, found that there were no differences between treatment groups in the 1-year risk for hospital admission (risk difference) [RD] = 0.1 percentage points; 95% CI, –0.3 to 0.6), 1-year risk for emergency surgery (RD = 0 percentage points; 95% CI, –0.1 to 0.1), 3-year risk for elective surgery (RD = 0.2 percentage points; 95% CI, –0.3 to 0.7) or 1-year risk for Clostridioides difficile (RD = 0 percentage points; 95% CI, –0.1 to 0.1).

In the Medicare group, there were no differences between the two treatment groups in the 1-year risk for hospital admission (RD = 0.1 percentage points; 95% CI, –0.7 to 0.9), 1-year risk for emergency surgery (RD = –0.2 percentage points; 95% CI, –0.6 to 0.1) or 3-year risk for elective surgery (RD = –0.3 percentage points; 95% CI, –1.1 to 0.4). The 1-year risk for C. difficile higher for patients who received metronidazole in addition to fluoroquinolone than those who received amoxicillin-clavulanate (RD = 0.6 percentage points; 95% CI, 0.2-1), according to the researchers.

“This is the first study to recommend that the treatment of outpatient diverticulitis with amoxicillin-clavulanate is as effective as metronidazole treatment with fluoroquinolone,” Peery said. “Physicians should consider treating outpatient diverticulitis with amoxicillin-clavulanate instead of metronidazole with fluoroquinolone. This approach has the potential to reduce the risk for a number of fluoroquinolone-related harms, including Clostridioides difficile infectious, without adversely affecting the results of diverticulitis. ”