Assessing Guideline Non-Adherence: Persistent Antibiotic Prescribing for Acute Uncomplicated Diverticulitis

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Data Quality: STRONG
Summary of  Annals of Internal Medicine https://doi.org/10.7326/ANNALS-25-05583 
Dr. Jesse D. Sutton  et al.

Points

This retrospective cohort study examined antibiotic prescribing trends for acute uncomplicated diverticulitis across 120 national Veterans Affairs facilities over a ten-year observation period.
Applying strict exclusion criteria to 70,391 initial clinical encounters yielded a final study cohort of 33,634 outpatient visits representing 28,474 unique patients.
Investigators observed that clinicians prescribed antibiotics in 96.6% of all recorded patient visits with annual adjusted prevalence rates consistently failing to fall below 95.6%.
Treatment options shifted over the decade as amoxicillin-clavulanate replaced fluoroquinolones as the predominant regimen, making up 42.7% and 45.6% of total prescriptions respectively.
The research team concluded that targeted antimicrobial stewardship interventions are necessary within outpatient departments to align clinical decision-making with modern selective-use guidelines.

Summary

This retrospective cohort study evaluated the longitudinal trends of outpatient antibiotic prescribing for acute uncomplicated diverticulitis across U.S. Department of Veterans Affairs (VA) healthcare facilities. Despite guideline updates beginning in 2015 that recommended selective rather than routine antibiotic administration, clinical practice has largely remained unchanged. The research sought to determine whether clinical decision-making had aligned with these evidence-based updates over a ten-year observation window spanning from October 1, 2015, to June 1, 2025.

Using electronic health records from 120 VA facilities, investigators identified 70,391 patient encounters meeting the diagnostic codes for uncomplicated diverticulitis. After applying strict exclusion criteria—including the absence of abdominal computed tomography confirmation, hospitalization within 24 hours, or a prior diverticulitis episode within 90 days—the final cohort consisted of 33,634 visits across 28,474 unique patients. Statistical analyses revealed that annual clinical visits remained stable, but antibiotics were prescribed in an overwhelming 96.6% of overall cases. The adjusted annual prevalence of antibiotic prescribing remained static, fluctuating narrowly between 95.6% and 97.9% across the decade.

The primary clinical choice of therapy evolved, transitioning from dominant fluoroquinolone-based regimens in 2015 to amoxicillin-clavulanate by 2025. Overall, these two regimens accounted for 45.6% and 42.7% of all prescriptions, respectively. While confidence intervals and hazard ratios were not reported in the primary outcomes for these static prescribing rates, a secondary validation sample confirmed the high accuracy of the electronic capture system. These findings suggest that substantial gaps persist between professional guidelines and clinical implementation, demonstrating that targeted antimicrobial stewardship interventions are required to curb unnecessary antibiotic exposures in outpatient emergency and urgent care settings.

Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05583

References

Sutton, J. D., Westanmo, A. D., Gravely, A. A., Geurkink, E. A., Drekonja, D. M., & Peterson, K. L. (2026). Outpatient antibiotic prescribing for uncomplicated diverticulitis in veterans affairs facilities: A retrospective cohort study. Annals of Internal Medicine, ANNALS-25-05583. https://doi.org/10.7326/ANNALS-25-05583