A recent study of acute diverticulitis conducted in Illinois compared 163 cases handled by gastroenterologists with 2535 cases handled by internists.1 The median hospital stay was 6 days for patients treated by gastroenterologists and 8 days for patients treated by internists (P<.001). Thirty-day readmission rates were 4.5% for patients treated by gastroenterologists vs 10% for patients treated by internists (P<.03). We gastroenterologists think we treat a population that is referred, sicker, and more complicated. If so, the numbers for internists should be much better than those for gastroenterologists, not worse! The authors of the study did not supply treatment data. In treating many cases of diverticulitis spanning many years, which were initially treated by caring family practitioners and internists, I sense a major factor is the too-frequent reliance on the use of a single antibiotic—currently, it is usually fluoroquinolones—that offers inadequate anaerobic coverage. I have treated patients in whom the third course of ciprofloxacin hydrochloride alone failed by adding metronidazole with dramatic resolution of symptoms.
Langdon DE. Differing Outcomes in Acute Diverticulitis Between Internists and Gastroenterologists. Arch Intern Med. 1998;158(3):302. doi: