An Umbrella Review of Systematic Reviews on the Utility of Antibiotics in Patients With Acute Uncomplicated Diverticulitis

Background: The role of antibiotics in acute uncomplicated diverticulitis (AUD) has been debated, as recent trials suggest antibiotics may not add benefit in mild AUD. Conclusions from systematic reviews on this subject have been inconsistent. This umbrella review aimed to synthesize and critically appraise the evidence from systematic reviews regarding the role of antibiotics in AUD. Methods: This was a PRISMA-compliant systematic review on the outcome of nonantibiotic conservative management compared to standard antibiotic therapy for AUD. PubMed, Scopus, Cochrane Library, and Google Scholar were searched through October 2025 for systematic reviews with meta-analyses. The main outcome measures were disease recurrence, complications, need for surgery, mortality, readmission, and hospital stay. Results: Fourteen systematic reviews with a median of 2487 patients per review were included. All reviews, except one, reported a similar likelihood of recurrence of AD between the 2 groups. The odds ratio of recurrence varied across the reviews from 0.66 to 1.01, and the risk ratio varied from 0.82 to 1.02. The likelihood of progression to complicated diverticulitis, perforation, abscess, mortality, and need for any surgical intervention was also similar between the 2 groups. Six reviews reported no difference in readmission, but one found higher readmission with antibiotics, and conversely another reported lower readmission with antibiotics. Five of 7 reviews reported shorter hospital stays with nonantibiotic management, with mean differences ranging across reviews from −1.18 to 0.19 days. Most reviews were of low or critically low quality. Conclusions: On the basis of low-certainty evidence, omitting antibiotics in AUD appears safe, with similar clinical outcomes to standard antibiotic therapy and a possible shorter hospital stay. High-quality trials remain needed to strengthen these findings.