Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis

Ribas, Yolanda; Bombardó, J.; Aguilar, Francesc; Jovell, Esther; Alcantara-Moral, Manel; Campillo, Francesc; Lleonart, Xavier; Serra‐Aracil, Xavier

doi:10.1007/s00384-010-0967-9

Cited by 35 publications

(24 citation statements)

References 34 publications

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“…Most patients with uncomplicated diverticulitis (Hinchey 0 or Ia) can be treated conservatively with a success rate of 93-100% (level C [15,81,82,83,84,85,86]). Conservative treatment includes antibiotics, starvation and bed rest in almost all studies.…”

Section: Treatment Of Uncomplicated Diverticulitismentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

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Section: Treatment Of Uncomplicated Diverticulitismentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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“…Most clinical guidelines have recommended treatment with a broad-spectrum antibiotic, usually including anaerobic cover, for a period of 7 to 10 days [15]. There is evidence that a short course of intravenous antibiotics followed by oral antibiotics, or even oral antibiotics alone, are just as effective in achieving symptom resolution as a full course of intravenous antibiotics [16,17].…”

Section: Management Of Acute Uncomplicated Diverticulitismentioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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“…Por todos estos motivos, el tratamiento de elección en la mayoría de los pacientes con diverticulitis aguda no complicada debe ser ambulatorio y con antibióticos vía oral. Aunque no existen datos sobre la aplicación del tratamiento ambulatorio en España, de acuerdo con las publicaciones existentes podemos estimar que es todavía muy limitada a pesar de que en los últimos años han aparecido nuevas evidencias que demuestran la seguridad y efectividad de esta forma de tratamiento 29,30,31,32,33 .…”

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Tratamiento ambulatorio de la diverticulitis aguda no complicada: impacto sobre los costes sanitarios

et al. 2013

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Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis

Abstract: Most patients with uncomplicated diverticulitis can be managed safely with oral antibiotic; thus, a very short hospital stay is a safe option.

Cited by 35 publications

References 34 publications

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Management of Acute Diverticulitis and its Complications

Tratamiento ambulatorio de la diverticulitis aguda no complicada: impacto sobre los costes sanitarios

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