Acute uncomplicated diverticulitis is a disease where outpouchings or blisters (termed Diverticulae) of the large bowel become inflamed resulting in pain and tenderness in the lower abdomen. Acute uncomplicated diverticulitis is currently treated with antibiotics although whether the antibiotics should be given through the veins or via the mouth is not known. Answering this question may allow treatment of the condition as an outpatient in the future.
Diverticulosis affects 5% of western society by the fifth decade, its prevalence increasing to over 50% in the ninth. As less than a quarter of acute admissions necessitate surgery, medical therapy remains the mainstay of management in the majority of cases. There are no prospective data to guide the identification of a specific cohort which may be managed with an oral antibiotic regimen, nor the efficacy of a specific antibiotic regimen.
The authors hypothesise that an oral antibiotic and fluid regimen is equally effective as intravenous antibiotics and 'bowel rest' in acute uncomplicated diverticulitis.
Approved by the Waterford Regional Ethics Board in 2002.
Multi-centre randomised controlled trial.
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Acute uncomplicated diverticulitis
Two intervention arms:
Intravenous arm: Intravenous ciprofloxacin (400 mg twice a day [BID]) and metranidazole (500 mg three times a day [TID]) with bowel rest for at least the first 24 hours.
Oral arm: Oral ciprofloxacin (500 mg BID) and metranidazole (400 mg TID) without complete bowel rest.
Duration of the interventions was equivalent to the length of stay, with a maximal antibiotic duration decided by the attending physician, typically 7-10 days.
Ciprofloxacin and metranidazole
Primary outcome measures
Resolution of symptoms. Three surrogates were used:
1. Resolution of left iliac fossa tenderness, assessed by the Wexford tenderness score (a locally validated score), daily assessment while an in-patient
2. Length of stay
3. Failure of oral therapy (requiring supplemental parenteral therapy). Follow-up: Until confirmatory/ refuting lower gastrointestinal (GI) series (endoscopic or contrast). Where such a test was not performed, follow-up to last out-patient appointment
Secondary outcome measures
The following were evaluated as potential surrogates for resolution:
1. Serial erythrocyte sedimentation rate (ESR). Follow-up: Until confirmatory/ refuting lower GI series (endoscopic or contrast). Where such a test was not performed, follow-up to last out-patient appointment
2. C reactive protein (CRP). Follow-up: Until confirmatory/ refuting lower GI series (endoscopic or contrast). Where such a test was not performed, follow-up to last out-patient appointment
3. White cell count (WCC). Follow-up: Until confirmatory/ refuting lower GI series (endoscopic or contrast). Where such a test was not performed, follow-up to last out-patient appointment
4. Temperature charts, daily assessment while an in-patient
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Patients presented with a clinical syndrome of left iliac fossa pain and local tenderness (Hinchey type I and II)
2. Both men and women
Target number of participants
Participant exclusion criteria
1. Those with complicated Diverticulitis (Hinchey III and IV)
2. Those in Septic Shock
3. Allergies to antibiotics used in the trial
4. Hepatic or Renal insufficiency
5. Diagnosis is not clear
6. Co-morbid conditions necessitating prolonged hospital stay
7. Pregnant women or women who are breast feeding
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Department of Surgical Oncology
Wexford General Hospital, Department of Surgery (Ireland)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting