Amoxicillin-clavulanate safe and effective compared with metronidazole-with-fluoroquinolone for dive

1.

Amoxicillin-clavulanate safe and effective compared with metronidazole-with-fluoroquinolone for diverticulitis


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M20-6315


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Treating diverticulitis in the outpatient setting with the antibiotic combination amoxicillin-clavulanate may reduce the risk for fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes. As such, physicians may want to consider choosing amoxicillin-clavulanate over metronidazole-with-fluoroquinolone for patients with a first occurrence of diverticulitis. Findings from two nationwide cohort studies are published in

Annals of Internal Medicine

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Uncomplicated diverticulitis is often managed in the outpatient setting with antibiotics to expedite recovery from the acute episode and reduce the risk for obstruction, abscess, or perforation. The two most commonly prescribed antibiotic regimens for this purpose are a combination of metronidazole and a fluoroquinolone or amoxicillin-clavulanate only. Despite being commonly prescribed for diverticulitis, the effectiveness and harms of these antibiotics remain unknown. This is a critical gap because the U.S. Food and Drug Administration has recommended that fluoroquinolones be reserved for use in conditions with no alternative treatment options because of the risk for potentially permanent and disabling fluoroquinolone-related adverse effects.

Researchers from the University of North Carolina School of Medicine studied two nationwide claims databases to compare the effectiveness of treating patients at the first occurrence of outpatient diverticulitis with either a combination of metronidazole and a fluoroquinolone or amoxicillin-clavulanate alone for the prevention of diverticulitis-related inpatient admission, urgent surgery, elective surgery, and emergency department visits. In addition, the researchers sought to assess the comparative risk for Clostridioides difficile infection (CDI) associated with these treatments. They found that amoxicillin-clavulanate was as effective as treatment with metronidazole-with-fluoroquinolone and there were negligible differences between groups in risk for the adverse outcomes measured. According to the researchers, these findings suggest that physicians may want to consider choosing amoxicillin-clavulanate over metronidazole-with-fluoroquinolone to reduce the risk for serious harms associated with fluoroquinolone use, including CDI.

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For an embargoed PDF, please contact Angela Collom at

[email protected]

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The corresponding author, Anne F. Peery, MD, MSCR, can be reached directly at

[email protected]

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2.

Doctors reverse miner’s nystagmus in migraine sufferer after prolonged light deprivation


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L20-1261


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Doctors used gradual exposure to light to restore vision to a migraine sufferer who developed miner’s nystagmus after an extended period of deliberate and severe light deprivation, to cope with severe light sensitivity. Miner’s nystagmus, an eye condition that causes jumping and blurred vision, was first recognized in the 1870s in coal miners who spent years working underground. A brief research report is published in

Annals of Internal Medicine

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Researchers from University College London observed a 57-year-old woman who reported having persistent and severe daily throbbing headaches over a period of years. She had associated motion sensitivity and severe phonophobia and photophobia, requiring her to wear a mask over her eyes to prevent exposure to light when outdoors. While she was able to eventually control her migraines with medication, she started to develop oscillopsia (jumping vision). She acknowledged that she had been living in continuous darkness for almost 2 years; her home was completely blacked out, with only a small camping light set to nocturnal settings for illumination. The team placed the patient on a program of gradually increasing light exposure using dimmer switches and a lux monitor. By week 5, she was able to tolerate 1 lux for 8 hours a day, and by week 13, she could tolerate 50 lux for 12 consecutive hours a day. Her nystagmus and oscillopsia resolved completely by 8 months.

According to the authors, their case highlights the extent to which neuroplastic and perfusion changes in the visual pathways are reversible even when exposed to extremes of physiology.

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For an embargoed PDF, please contact Angela Collom at

[email protected]

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The corresponding author, Diego Kaski, PhD, can be reached through Chris Lane at

[email protected]

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Also in this issue:

Dr. Mom: Things I Took for Granted Pre-Pandemic

Grace Farris, MD

Graphic Medicine

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G21-0011

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