February 27, 2013

DynaMed EBM Journal Volume 8, Issue 9

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: February 27, 2013

Expiration Date: February 27, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote EducationCompany and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1210392Z


Last week 447 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and 263 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Antibiotics May Not Improve Outcomes in Uncomplicated Left-Sided Diverticulitis
Reference: Cochrane Database Syst Rev 2012 Nov 14;(11):CD009092 (level 2 [mid-level] evidence)

Practice parameters from the American Society of Colon and Rectal Surgeons (ASCRS) recommend oral or IV broad-spectrum antibiotics for nonoperative management of acute left-sided diverticulitis (Dis Colon Rectum. 2006 Jul;49(7):939-44), and antibiotic treatment has become the standard of care for uncomplicated disease. However, little research has been performed to assess the efficacy of this approach. A recent Cochrane review identified only 1 unblinded trial that compared antibiotics to no antibiotics in patients with uncomplicated left-sided diverticulitis.

In this trial, 623 patients (mean age 57 years) with acute uncomplicated left-sided diverticulitis verified by computed tomography were randomized to broad-spectrum antibiotics for ≥ 7 days vs. no antibiotics and followed for 1 year (Br J Surg 2012 Apr;99(4):532). Initial IV treatment was a combination of a second- or third-generation cephalosporin and metronidazole, or carbapenem antibiotics, or piperacillin-tazobactam. IV treatment was followed by oral antibiotics (ciprofloxacin or cefadroxil with metronidazole). All patients received IV fluids.

There were no significant differences between the groups in any clinical outcomes. Recurrent diverticulitis with hospital readmission occurred in 15.8% with antibiotics vs. 16.2% without antibiotics. Complications (including sigmoid perforations or abscesses) occurred in 1% with antibiotics vs. 1.9% without, and sigmoid resections were performed in 1.6% vs. 2.3%. The median hospital stay was 3 days in each group.

The 2 other trials included in the Cochrane review addressed the comparative efficacy of different antibiotic regimens, and found no significant differences in outcomes comparing short duration of IV treatment vs. > 7 days of IV treatment (1 trial with 44 patients) or comparing cefoxitin vs. gentamicin plus clindamycin (1 trial with 51 patients).

For more information, see the Diverticulitis topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

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