Antibiotics still routine for uncomplicated diverticulitis despite guideline shift

Clinical Takeaway: For immunocompetent, clinically stable patients with uncomplicated diverticulitis, consider guideline-supported selective antibiotic use rather than reflex prescribing.

Routine antibiotics may expose many low-risk patients to avoidable adverse effects, drug interactions, C. difficile infection risk, and antimicrobial resistance pressure without clear clinical benefit.

Antibiotics remain the default for outpatient uncomplicated diverticulitis across Veterans Affairs facilities, despite nearly a decade of guideline shifts encouraging more selective treatment.

In a retrospective cohort study, investigators analyzed more than 33,000 emergency department and urgent care visits for uncomplicated diverticulitis at 120 VA facilities from October 2015 through June 2025. Antibiotics were prescribed in 96.6% of visits overall, with little year-to-year change after 2015, when the American Gastroenterological Association and other professional societies began recommending that many uncomplicated cases could be managed without routine antibiotics.

The findings suggest a persistent gap between evidence-based recommendations and real-world prescribing. Although the study was observational and focused on VA patients, its size and decade-long span underscore how difficult it can be to de-implement long-standing practices, even after guidelines change.

The authors concluded that prescribing patterns have “not meaningfully aligned with evolving recommendations,” pointing to a need for targeted stewardship interventions in urgent care and ED settings.

For clinicians, the message is not that antibiotics should never be used. Rather, the study reinforces the importance of identifying patients who may safely avoid them, while reserving treatment for higher-risk presentations, immunocompromised patients, systemic signs of infection, or concern for complicated disease.

Source: Sutton JD, et al. 2026 June 22. Ann Intern Med. Outpatient Antibiotic Prescribing for Uncomplicated Diverticulitis in Veterans Affairs Facilities: A Retrospective Cohort Study