LAUSR

TO THE EDITOR: We read with interest Gaber and colleagues' article (1) comparing the efficacy of different antibiotics for outpatient diverticulitis. Although it is notable that they evaluated a large number of patients over a considerable length of time, 2 aspects of the study warrant further scrutiny. As the authors briefly mention, several important randomized trials have taken place over the study period that have questioned the value of any antibiotics for uncomplicated diverticulitis—a category into which outpatient diverticulitis would presumably fall (2, 3). Subsequent meta-analyses have corroborated these findings, which has led various national organizations both in Europe and the United States to change their practice parameters accordingly (4). In the era of antibiotic stewardship, this fact needs to be reiterated by the authors. Antibiotics in an uncomplicated setting should be reserved for patients who are frail or immunocompromised or have substantial comorbidities. These high-risk features cannot be gleaned from the data presented. Regardless, outpatient treatment of such patients who may be at increased risk for complications is questionable. In addition, the importance of computed tomography (CT) to confirm the diagnosis of diverticulitis and determine its severity cannot be overemphasized. The sensitivity and specificity for diverticulitis of a CT scan of the abdomen and pelvis have been well proved (5). With rates of imaging as low as 40% in the amoxicillin–clavulanate Medicare group, the accuracy of the diagnosis is thus questionable, particularly because clinical suspicion of diverticulitis is correct in only 40% to 65% of patients.