Antibiotics in Uncomplicated Acute Diverticulitis: To Give or Not to Give?

Rezapour, Mona; Stollman, Neil

doi:10.1159/000489631

Cited by 14 publications

(10 citation statements)

References 38 publications

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“…Or do you mean SUDD?] has been challenged171 owing to the evolving concepts in the pathogenesis of the disease (shifting from bacterial infection to an inflammatory process), the growing concerns about antibiotic overuse and the results of several studies. Two RCTs172,173 questioned the antimicrobial use and showed that observational treatment can be considered appropriate [Au: how long was observational treatment sufficient?…”

mentioning

confidence: 99%

Colonic diverticular disease

Tursi

Scarpignato

Strate

et al. 2020

Nat Rev Dis Primers

162

172

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Queries are meant to draw your attention to edits, inconsistencies or issues that are unclear. If we just ask you to confirm edits are correct, a simple yes/ok between the brackets will do [Au: OK? Is this what you meant? Edits OK? yes]. If questions are asked, please rephrase/update the manuscript text when addressing queries, so that the message is conveyed to the reader (do NOT just type your answer to our query).] [Au: Throughout the manuscript, please use consistent terminology. For example, acute diverticulitis is diverticular disease and in several instances, they are mentioned separately. For clearer understanding, please use consistent terminology and define cleary what diverticular disease refers to. Similarly, there is a slight ambiguity between the terms diverticulosis and asymptomatic diverticulosis. My understanding is that diverticulosis is always asymptomatic. Please refer to them consistently if they are used to refer to the same condition. Is acute uncomplicated diverticulitis as in some instances, its refered to as uncomplicated acute diverticulitis? Please also use the abbreviation, AUD, if this terminology is widely accepted in the field. Just wanted to flag these here to make it easier for you to address.][Au: Important! As I am managing the references for this manuscript, it is essential that changes to references are noted to me in a comment rather than edited manually (as this will likely unlink the references and cause much confusion). If a reference needs to be added, include the full reference details (at a minimum, PMID or DOI are needed) and precise location to be cited. If a reference needs to be deleted, state which reference (author, year) and not just the reference number (as this will change with every change to the references).You can move text around, including the references associated with any given statement, but please don't edit the reference list at the end of the document.

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mentioning

confidence: 99%

Colonic diverticular disease

Tursi

Scarpignato

Strate

et al. 2020

Nat Rev Dis Primers

162

172

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“…Conservative treatment strategy without antibiotics in patients with uncomplicated AD has proven to be safe, with long‐term outcomes, in terms of recurrence, complications and need for surgery, being similar to those treated with antibiotics [ 84 , 85 , 86 , 87 , 88 ]. However, CRP level >170 mg/l is a risk factor for non‐antibiotic treatment failure [ 89 ] and selective, rather than routine, omission of antibiotics is still recommended [ 90 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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“…Although conservative treatment of AUD without antibiotics has shown to be feasible, safe, and effective [4], there is some evidence and agreement that antibiotics are still indicated in immunocompromised patients, with comorbidities as chronic kidney disease, collagen-vascular disease, diabetes, severe signs of sepsis, in patients on chronic corticosteroid therapy, or pregnant females, as these patients have a higher risk of treatment failure [4,10,11].…”

Section: Evidence Promentioning

confidence: 99%

Hot Topics in Surgical Management of Acute Diverticulitiss

Binda

Papa

Persiani

et al. 2020

JGLD

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In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

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Antibiotics in Uncomplicated Acute Diverticulitis: To Give or Not to Give?

Cited by 14 publications

References 38 publications

Colonic diverticular disease

Colonic diverticular disease

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Hot Topics in Surgical Management of Acute Diverticulitiss

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