Title : Compliance with national guidelines on antibiotic prescription in acute diverticulitis: A quality improvement project
Abstract:
Introduction: Acute diverticulitis, a common surgical condition, can be classified as uncomplicated or complicated. National guidelines recommend antibiotics only for patients with complicated diverticulitis, immunosuppression, or systemic illness. This quality improvement project assessed compliance with these guidelines, identified gaps in practice, and implemented measures to improve adherence.
Methods: A two-cycle audit was conducted. The first cycle, retrospective in nature, reviewed cases from July to December 2024. Following identification of poor compliance, targeted interventions such as staff education sessions and guidelines posters were introduced. The second cycle was conducted prospectively from February to May 2025. Inclusion criteria were adult patients with CT-confirmed acute diverticulitis. Data were obtained from electronic patient and medication records. The audit standard, based on NICE guidance, required 100% compliance: no antibiotics for uncomplicated, systemically well and not immunocompromised and antibiotics for complicated ones, systemically unwell or immunocompromised.
Results: 43 patients were included in the first cycle (median age 65; gender ratio 1:1). Of the 24 patients with uncomplicated diverticulitis, all were prescribed antibiotics conferring 0% compliance against set standard. The remaining 19 patients with complicated diverticulitis, all received appropriate antibiotics (100$% compliance). 35 patients were included in the second cycle. 26/35 had uncomplicated diverticulitis; of these, 8 (31%) required antibiotics due to systemic illness or immunosuppression, 12 (46%) were not given antibiotics as per standard, while 6 (23%) received antibiotics against the standard. Compliance therefore improved from 0 to 77% for managing uncomplicated diverticulitis. All remaining 9/35 patients with complicated diverticulitis received appropriate antibiotics, conferring 100%, as noted during previous cycle.
Conclusion: This project demonstrate that targeted interventions can significantly improve adherence to antibiotic guidelines, enhancing patient care and reducing unnecessary treatment burden.
