Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study

Serrano González, Javier; Román García de León, Laura; Galindo Jara, Pablo; Lucena de la Poza, José Luis; Sánchez Movilla, Arsenio; Colao García, Laura; García Schiever, Jesús Gabriel; Varillas Delgado, David

doi:10.17235/reed.2023.9737/2023

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Our search yielded twelve studies [ 16 – 29 ] comparing NABX versus ABX treatment in patients diagnosed with Hinchey 1a diverticulitis (PRISMA flow chart - Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 …”

Section: Resultsmentioning

confidence: 99%

“…For the former, twelve studies [ 16 – 29 ] with a total of 3,875 patients divided into a NABX group ( n = 2,008) and ABX group ( n = 1,867) were included. For management in the IP vs. OP setting, twelve studies [ 23 , 30 – 40 ] with 2,286 patients (OP, n = 1,021; IP, n = 1,265) were included.…”

Section: Discussionmentioning

confidence: 99%

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

Mohamedahmed,

Zaman,

Das

et al. 2024

Int J Colorectal Dis

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Background To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis. Methods A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters. Results The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61). Conclusion Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

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“…Our search yielded twelve studies [ 16 – 29 ] comparing NABX versus ABX treatment in patients diagnosed with Hinchey 1a diverticulitis (PRISMA flow chart - Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%