Infectious Disease

Therapy of diverticulitis with amoxicillin clavulanate avoids dangers related to fluoroquinolones

February 22, 2021

2 min read

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Disclosure:
Peery reports on grants from the NIH / National Institute for Diabetes and Digestive and Kidney Diseases over the course of the study. In the study you will find all relevant financial information from all other authors.

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Outpatient treatment for diverticulitis with amoxicillin clavulanate is “as effective” as treatment with a combination of metronidazole and fluoroquinolone, a researcher told Healio Primary Care.

The data show that treatment with amoxicillin clavulanate does not carry the same risk of adverse events related to fluoroquinolones.

Acute diverticulitis is responsible for $ 5.5 billion in healthcare spending each year, according to researchers. The condition is common – 209 cases per 100,000 person-years in the United States.

“The two most commonly prescribed antibiotic therapies for outpatient diverticulitis are a combination of metronidazole and just a fluoroquinolone or amoxicillin clavulanate,” 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.

“While both therapies are considered first-line therapy, they differ significantly in their mechanisms of action and side effects,” she said. “This is the ideal comparative efficacy study, especially given the growing list of harms associated with fluoroquinolone use.”

Peery and colleagues compared the effectiveness and harm of treatments in two cohorts of patients with acute diverticulitis. The first group included US citizens ages 18 to 64 in the IBM MarketScan commercial claims and encounters database (n = 119,521) and the second group included Medicare patients aged 65 or older between 2006 and 2015 ( n = 20,348).

Researchers found that in the MarketScan cohort, there were no differences between treatment groups in terms of the 1-year risk of hospitalization (risk difference) [RD] = 0.1 percentage points; 95% CI, -0.3 to 0.6), 1-year risk for urgent operations (RD = 0 percentage points; 95% CI, -0.1 to 0.1), 3-year risk for elective operations (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 cohort, there were no differences between the two treatment groups for 1-year risk of hospitalization (RD = 0.1 percentage points; 95% CI, -0.7 to 0.9) and 1-year Urgent Surgery Risk (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). According to the researchers, the 1-year risk of C. difficile was higher in patients who received metronidazole plus fluoroquinolone than in patients who received amoxicillin clavulanate (RD = 0.6 percentage points; 95% CI, 0.2- 1).

“This is the first study to suggest that outpatient diverticulitis treatment with amoxicillin clavulanate is as effective as treatment with metronidazole with a fluoroquinolone,” said Peery. “Doctors should consider treating ambulatory diverticulitis with amoxicillin clavulanate instead of metronidazole with a fluoroquinolone. This approach has the potential to reduce the risk of numerous fluoroquinolone-related harms, including Clostridioides difficile infection, without adversely affecting diverticulitis outcomes. “

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