Management of acute uncomplicated diverticulitis without antibiotics: compliance and outcomes -a retrospective cohort study

Abstract

Methods Recent randomized control trials (RCTs) have confirmed that antibiotics in acute uncomplicated diverticulitis (AUD) neither accelerate recovery nor prevent complications or recurrences. A retrospective cohort study was conducted, including all consecutive AUD patients hospitalized 2015- 2018 at Helsingborg Hospital (HH) and Skåne University Hospital (SUS), Sweden. HH had implemented a non-antibiotic treatment protocol in 2014 while SUS had not. Main outcomes were proportion of patients treated with antibiotics, complications, recurrences, and adherence to routinely colon evaluation. Results A total of 583 AUD patients were enrolled, 388 at SUS and 195 at HH. The diagnosis was CT-verified in 320 (83%) vs. 186 (95%) patients respectively (p < 0.001). Forty-three (11%) and 94 (48%) of patients respectively did not receive antibiotics during hospitalization (p < 0.001). CRP was higher in the antibiotic group compared to the non-antibiotic group, both at admission and peak (90 mg/L vs 65 mg/L; p = 0.016) and (138 mg/L and 97 mg/L; p < 0.001). There were no significant differences in recurrences (22.0% vs. 22.6%; p = 0.87) and complications (2.5% vs. 2.9%; p = 0.77) between the antibiotic/non-antibiotic groups. Conclusion The structured treatment protocol led to reduced antibiotic use and a higher standard of care in terms of CT-verification. Clinicians’ compliance to the treatment protocol and best clinical practice was poor and warrants further studies.

Recurrence of Uncomplicated Diverticulitis: A Meta-Analysis

“…Two authors independently extracted data from eligible studies. The following data were extracted from all the eligible studies: the family name of the first author, year of publication, study location, number of patients analyzed, study type, lesion locations, medical treatment, and follow-up period [8][9][10]13,. This study was performed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).…”

“…Traditionally, treatment of UCD includes bowel rest, intravenous fluids, and antibiotics. However, recent randomized controlled trials (RCTs) have reported the comparison between antibiotics and non-antibiotics therapies in acute diverticulitis [8][9][10]. Avoiding antibiotics as a UCD treatment has been recommended in guidelines based on the results of previous RCTs and other studies [8,[11][12][13][14].…”

“…However, recent randomized controlled trials (RCTs) have reported the comparison between antibiotics and non-antibiotics therapies in acute diverticulitis [8][9][10]. Avoiding antibiotics as a UCD treatment has been recommended in guidelines based on the results of previous RCTs and other studies [8,[11][12][13][14]. However, antibiotics are commonly used in many institutions [15,16].…”

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

“…Exclusion criteria : >2 criteria of SIRS upon presentation, pregnancy, ASA ≥ 4, previous drug reactions to the antibiotics, used any of the following before presentation: steroids, immunomodulators or biologics, regular nonsteroidal anti-inflammatory drugs, or antibiotics. Hinchey Stage 1a 1 month Azhar et al [ 28 ] Sweden Retrospective Cohort NABX: 195 ABX: 388 Inclusion criteria : uncomplicated AD diagnosed on CT (absence of complications such as abscess, fistula, stricture, bowel obstruction, or peritonitis with perforation) Exclusion criteria : general peritonitis or sepsis, immunosuppressed patients and patients with ongoing antibiotic treatment at admission Uncomplicated AD 3 months Serrano Gonzalez et al [ 29 ] Spain Prospective Cohort NABX: 182 ABX: 179 Inclusion criteria : uncomplicated AD on CT, age between 18–70 years, ASA I-III, sufficient social and/or family support, patient able to tolerate orally Exclusion criteria : complicated AD (evidence of stenosis, abscess, pneumoperitoneum or fistula on CT, or signs of haemorrhage, obstruction or sepsis), pregnancy, immunosuppressed patients, BMI ≥ 40 kg/m2 Uncomplicated AD 24 months NABX no antibiotics, ABX antibiotics, AD acute diverticulitis, CT computed tomography, RCT randomised controlled trial, BMI body mass index, SD standard deviation …”

Abordagem geral da doença diverticular e da diverticulite

“…Universidade de Vassouras (UV), Vassouras -RJ 2. Faculdade de Medicina de Catanduva (UNIFIPA), Catanduva -SP.…”