Antibiotic Prescription for Acute Diverticulitis: Evaluation of Compliance With National Guidelines

TL;DR

This study evaluated how well a hospital followed national guidelines for prescribing antibiotics in acute diverticulitis and found improvements after educational interventions.

Contribution

The study demonstrates a successful quality improvement initiative to align antibiotic use with national guidelines for diverticulitis management.

Findings

Initially, 0% compliance with guidelines for uncomplicated diverticulitis improved to 66% after interventions.

All patients with complicated diverticulitis consistently received appropriate antibiotics.

Unnecessary antibiotic prescriptions were reduced in uncomplicated cases following educational measures.

Abstract

Introduction: Diverticulitis is a common surgical problem that can be categorised as uncomplicated or complicated diverticulitis. National guidelines for managing acute diverticulitis recommend that antibiotics should only be given to patients who are systemically unwell, have a background of immunosuppression or have complicated diverticulitis. We analysed the compliance with these guidelines at our hospital, identified gaps, and introduced appropriate measures to improve service provision.

Methods: This was a closed-loop audit. The first cycle was a retrospective analysis conducted between July and December 2024. Following the identification of gaps in practice, appropriate educational interventions were undertaken, and a second audit cycle was conducted to evaluate their impact. The second cycle was prospectively undertaken between February and May 2025. Adult patients with a computed tomography-confirmed diagnosis of acute diverticulitis met the inclusion criteria. Measured outcomes included demographics, signs and symptoms at presentation, relevant imaging, observations and antibiotic prescription. Standards were derived from National Institute for Health and Care Excellence (NICE) guidelines with target compliance set at 100%.

Results: Forty-three patients were evaluated during the first audit cycle. 24/43 (56%) patients had uncomplicated diverticulitis. Of these, 3/24 were immunocompromised and were appropriately prescribed antibiotics; all the remaining 21/24 patients with a competent immune system and systemically well were given antibiotics against the recommendations, resulting in non-compliance with standards. 19/43 (44%) had complicated diverticulitis, with all receiving antibiotics as recommended, therefore resulting in 100% compliance. Following appropriate interventions, the subsequent audit cycle was conducted, where 35 patients were included in the second cycle. 26/35 had uncomplicated diverticulitis; of these, 8 (31%) required antibiotics due to systemic illness or immunosuppression, 12 (46%) were not prescribed antibiotics in line with the standard, while 6 (23%) unnecessarily received antibiotics against the standard. Compliance therefore improved from 0% to 66% between audit cycles with regards to managing uncomplicated diverticulitis. All nine of the remaining 35 patients with complicated diverticulitis received appropriate antibiotics, achieving 100% compliance, consistent with the previous audit cycle.

Conclusions: This quality improvement project highlights the importance of differentiating amongst complicated and uncomplicated diverticulitis, which therefore dictates management, and potentially avoids unnecessary administration of intravenous antibiotics and hospital stay. This article aims to increase awareness among relevant surgical teams in order to improve patient outcomes and reduce pressures on the health care system.