Rethinking Antibiotics for Diverticulitis Treatment

Diverticular disease is a common problem in the United States, and more people are being diagnosed with it each year. Acute diverticulitis, a specific condition within this disease, leads to many visits to Emergency rooms. In fact, it accounts for more than 360,000 visits annually. Despite research suggesting that Antibiotics are not always needed for treating uncomplicated cases, they continue to be the main treatment option in the United States.

#The Problem with Antibiotics

Using antibiotics when they are not necessary can cause problems. It can lead to antibiotic resistance, which makes infections harder to treat. In the United States, antibiotic-resistant infections develop in over 2.8 million people each year, causing more than 35,000 deaths. When antibiotics are overused, Patients may have to stay in the hospital longer, return to the hospital more often, and there can be higher death rates linked to infections. This overuse also costs the healthcare system about $55 billion every year. Reducing the use of antibiotics for treating uncomplicated diverticulitis can help educate doctors and lessen the number of prescriptions.

#Why Do Doctors Still Use Antibiotics?

Even with evidence suggesting that antibiotics aren’t always necessary, they remain the standard treatment in many places. Studies done in Europe have shown that treating patients with supportive care instead of antibiotics does not lead to worse outcomes, such as perforation or abscess formation. Major medical organizations have also stated that uncomplicated cases can be treated without antibiotics. The reasons for the ongoing use of antibiotics include a lack of awareness among doctors about recent guidelines, fears of legal issues associated with not prescribing antibiotics, and patients expecting to receive antibiotics when they seek treatment.

#The Need for More Research

A study in North America comparing antibiotics to no antibiotics for treating uncomplicated diverticulitis could help reduce the unnecessary use of antibiotics. This research aims to understand how patients feel about participating in such a study.

#Methods of Study

This research included two parts: focused interviews and a survey. The interviews were conducted in person at the emergency department and over the phone with patients who had previously been treated for diverticulitis. The study was approved by an ethics board, allowing verbal consent for interviews and waiving the need for written consent for surveys.

#Focused Interviews

Semi-structured interviews were conducted to gather detailed patient perspectives. Patients eligible for interviews were adults who spoke English and had a diagnosis of acute diverticulitis. Those with more complicated cases or other serious health issues were excluded. Interviews occurred from October to December 2022, and once the researchers felt that no new themes were emerging, they concluded the interview phase.

The interview guide was created to help patients express their thoughts and opinions about diverticulitis. The guide included open-ended and focused questions about their experiences with antibiotics, concerns about resistance, and treatment guidelines.

#Qualitative Analysis

The interviews were recorded, transcribed, and then analyzed to find common themes. The researchers categorized the data to determine key factors affecting patient decisions about trial participation.

#Survey Methodology

The interviews informed the creation of an online survey to quantify the thoughts and beliefs of a larger group of people with diverticulitis. Participants for the survey were again adults with a history of diverticulitis and excluded those with serious underlying conditions.

The survey asked patients to rank various factors related to their experiences and opinions about treatment. It was tested by doctors and patients before being distributed online. Participants were recruited through social media and hospital records. Those who completed the survey had a chance to enter a raffle for a gift certificate.

#Survey Data Analysis

The data collected from the surveys were analyzed for trends and responses. The analysis looked at average scores and rankings for different factors. The data included responses from those willing and unwilling to participate in a trial.

#Participant Characteristics

The interviews involved 13 patients-nine in person at the hospital and four over the phone. Most of the participants were women and White. The average age was about 62 years, and the interviews lasted around 16 minutes each.

#Key Themes from Interviews

Two main themes emerged from the interviews: how patients gather information to make decisions and what factors influence their willingness to join a trial. Participants often drew upon personal experiences and relied heavily on their healthcare providers' recommendations.

Some participants hesitated to take part in a trial because they doubted that observation could work as a treatment. Others expressed a desire to avoid antibiotics in the future and felt that being part of a study would help them do that.

#Survey Results

From a total of 218 survey participants, about 62% expressed a willingness to participate in a trial comparing antibiotics with a placebo. The top reasons for wanting to take part in the trial included the idea of helping improve treatment guidelines and the desire to avoid antibiotics in the future.

When looking at their decision-making processes, most participants stated that their doctor's opinion was the most important factor, followed by their own past experiences. A significant concern among some respondents was the fear of needing an ostomy bag as a result of diverticulitis.

#Qualitative Insights from Surveys

Among the 83 people who did not want to participate, many explained that they feared missing out on antibiotics and were uncertain about an antibiotic-free treatment approach. In contrast, those willing to participate mentioned a desire to help advance research and gain a better understanding of diverticulitis.

#Discussion and Conclusions

More than half of those surveyed were open to participating in a trial comparing antibiotics and placebo Treatments for acute diverticulitis. This interest indicates that recruiting participants for such a trial is possible and may lead to valuable insights.

The study highlights the importance of patient trust in healthcare providers and how their opinions can significantly shape patient decisions about treatment options. Many patients are inclined to follow antibiotic protocols, largely based on their healthcare provider's guidance.

While recruiting patients in the emergency department provides valuable insights, the study has some limitations. There may be a bias since the research focuses on those who agreed to participate. The sample was primarily White, which may overlook other patient voices. Additionally, some participants misunderstood parts of the trial information, which could have affected their willingness to participate.

Overall, patients' decision-making about diverticulitis treatment closely reflects their relationship with their healthcare providers and their perceptions of available treatment options. As providers adopt and endorse antibiotic-free approaches, these perspectives may gradually change. Conducting a trial comparing antibiotics and placebo for acute uncomplicated diverticulitis is feasible and may be welcomed by patients.