{
    "abstract": "Historically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America. The purpose of this SAGES White Paper was to review the available evidence on antibiotic omission in uncomplicated diverticulitis and to explore methods of safe implementation.\nA task force within the SAGES Colorectal Surgery Committee was formed to work on this White Paper. The committee and its leadership approved an outline that would focus on the following topics: (1) Defining the problem with unnecessary antibiotic exposure; (2) Evaluating the evidence on antibiotic omission in uncomplicated diverticulitis; (3) Identifying the appropriate patient for antibiotic omission; (4) Outlining how to counsel patients who are treated without antibiotics; (5) Reviewing methods to safely implement this practice in both the hospital and community setting. These topics were divided up among members of the task force who performed a structured literature search in preparation for their assignments.\nAntibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.\nThe existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.",
    "authors": [
        {
            "affiliation": "Division of Colon and Rectal Surgery, Department of Surgery, Jewish General Hospital, McGill University, 3755 Cote Saint-Catherine Road, Montreal, QC, H3T1E2, Canada. richard.garfinkle@mail.mcgill.ca.",
            "firstname": "Richard",
            "initials": "R",
            "lastname": "Garfinkle"
        },
        {
            "affiliation": "Division of Colon and Rectal Surgery, University of South Florida Morsani College of Medicine, Tampa Bay, FL, USA.",
            "firstname": "Robert D",
            "initials": "RD",
            "lastname": "Bennett"
        },
        {
            "affiliation": "Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.",
            "firstname": "Siva",
            "initials": "S",
            "lastname": "Dantu"
        },
        {
            "affiliation": "Nationwide Children's Hospital, Ohio State Wexner Medical Center, Columbus, OH, USA.",
            "firstname": "Alessandra",
            "initials": "A",
            "lastname": "Gasior"
        },
        {
            "affiliation": "Section of Colon and Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.",
            "firstname": "Alexander T",
            "initials": "AT",
            "lastname": "Hawkins"
        },
        {
            "affiliation": "Department of Surgery, Thunder Bay Regional Health Sciences Center, Thunder Bay, ON, USA.",
            "firstname": "Jessica",
            "initials": "J",
            "lastname": "Holland"
        },
        {
            "affiliation": "Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.",
            "firstname": "Ana Sofia",
            "initials": "AS",
            "lastname": "Ore"
        },
        {
            "affiliation": "Department of Surgery, University of Chicago, Chicago, IL, USA.",
            "firstname": "Virginia O",
            "initials": "VO",
            "lastname": "Shaffer"
        },
        {
            "affiliation": "Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.",
            "firstname": "James P",
            "initials": "JP",
            "lastname": "Taylor"
        },
        {
            "affiliation": "Department of Surgery, Mount Sinai Hospital, New York, NY, USA.",
            "firstname": "Patricia",
            "initials": "P",
            "lastname": "Sylla"
        },
        {
            "affiliation": "Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.",
            "firstname": "Elisabeth C",
            "initials": "EC",
            "lastname": "McLemore"
        },
        {
            "affiliation": "Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.",
            "firstname": "Marylise",
            "initials": "M",
            "lastname": "Boutros"
        }
    ],
    "conclusions": "The existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.",
    "copyrights": "\u00a9 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
    "doi": "10.1007/s00464-025-11738-w\n10.1097/00000658-192409000-00014\n10.1136/bmj.2.4427.635\n10.1016/0002-9610(77)90195-7\n10.1016/S0140-6736(64)92790-4\n10.1053/j.gastro.2018.12.033\n10.1097/01.mcg.0000225502.29498.ba\n10.1080/00365520600780650\n10.1111/j.1463-1318.2011.02609.x\n10.3109/00365521.2014.968861\n10.1002/bjs.8688\n10.1002/bjs.10309\n10.1016/j.cgh.2020.03.049\n10.1097/SLA.0000000000005031\n10.1053/j.gastro.2020.09.059\n10.1007/s00464-019-06882-z\n10.1097/DCR.0000000000001679\n10.1097/DCR.0000000000001815\n10.1503/cmaj.140848\n10.1016/S1081-1206(10)61100-3\n10.2165/00002018-200730080-00007\n10.1016/S0025-7125(16)30761-1\n10.2165/00003495-199651060-00010\n10.1136/gutjnl-2016-312297\n10.1016/j.jinf.2019.10.008\n10.1093/cid/cir301\n10.1056/NEJMra0707500\n10.1089/sur.2018.115\n10.1016/j.ijid.2018.01.011\n10.1186/s13017-023-00518-3\n10.1053/gast.2002.32978\n10.1159/000354035\n10.1097/DCR.0000000000001324\n10.1016/j.surg.2021.07.012\n10.1111/j.1572-0241.2005.41154.x\n10.1111/ans.17913\n10.1007/s00384-017-2912-7\n10.1007/s00384-017-2919-0\n10.1097/DCR.0000000000000579\n10.1007/s11605-019-04153-9\n10.1007/s00384-017-2847-z\n10.1016/j.jamcollsurg.2017.02.016\n10.1007/s00384-018-3055-1\n10.1007/s00268-017-3931-9\n10.1007/s43678-023-00606-y\n10.1186/s12873-022-00584-x\n10.1080/00365521.2018.1552987\n10.1186/s13017-020-00313-4\n10.7326/M21-2710\n10.1002/jhm.13257\n10.7326/M15-1840\n10.1001/jama.282.15.1458",
    "journal": "Surgical endoscopy",
    "keywords": [
        "Antibiotics",
        "Evidence",
        "SAGES",
        "Uncomplicated diverticulitis",
        "White paper"
    ],
    "methods": null,
    "publication_date": "2025-04-23",
    "pubmed_id": "40263135\n17865098\n20786386\n3513451\n835782\n14092958\n30660732\n16885694\n17190761\n21689302\n25369865\n32240832\n33279517\n31250244\n32384404\n33093297\n25404399\n17165279\n17696583\n3280909\n8736621\n27531828\n30002765\n31629863\n21653301\n18971494\n30204549\n23969324\n22549495\n30664553\n34344525\n735943\n15784040\n35866354\n29038965\n29075917\n27145310\n30859428\n28664347\n28450063\n29679152\n28258453\n37861926\n35189812\n30650309\n32381121\n38093492\n26785402\n26619058\n10535437",
    "results": "Antibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.",
    "title": "SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how.",
    "xml": "<Element 'PubmedArticle' at 0x7885040e57b0>"
}