Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics

Kim, Jeong Yeon; Park, Sung Gil; Kang, Hee Joon; Lim, Young Ah; Pak, Kyung Ho; Yoo, Taiwoo; Cho, Won Tae; Shin, Dong Woo; Kim, Jong Wan

doi:10.1007/s00384-019-03343-w

Cited by 23 publications

(36 citation statements)

References 37 publications

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“…In each of these studies, the patients recovered without complications after antibiotic treatment. In an RCT on right colonic diverticulitis, the frequency of antibiotic administration after not receiving antibiotics was 3%, which is similar to the findings for left colonic diverticulitis [6]. Compared with these studies, the frequency in our study was slightly higher (6.7%); however, our sample size was smaller than that of other studies.…”

Section: Discussionsupporting

confidence: 80%

“…When we conducted a brief search within several major databases to find literature within the past 5 years, we found one RCT investigating treatment outcomes between a group of Korean patients taking routine antibiotics for uncomplicated right colonic diverticulitis and a group treated without antibiotics [6]. In a total of 125 patients, there was no difference in the length of hospital stay between the groups (p = 0.983), although the mean hospital stay was 5.3 days, which was longer than that in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…According to guidelines published by the Japan Gastroenterological Association in 2019, antibiotics are recommended for patients with uncomplicated right colonic diverticulitis, because there are not enough studies to justify discontinuing its use [5]. However, recently published results of a randomized control trial (RCT) in patients with uncomplicated right colonic diverticulitis suggest that there is no need for antibiotics in these patients [6].…”

Section: Introductionmentioning

confidence: 99%

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Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study

Lee

Park

et al. 2021

PLoS ONE

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We aimed to investigate whether antibiotic administration is necessary for patients with uncomplicated right colonic diverticulitis. Data from patients diagnosed with uncomplicated right colonic diverticulitis, who received inpatient treatment at a single center between January 2019 and January 2021, were retrospectively examined. The patients were divided into two groups according to whether antibiotics were administered. The patients were matched between groups using propensity score matching in a 1:1 ratio using logistic regression with the nearest-neighbor method. The primary study outcome was the length of hospital stay, and the secondary outcomes were time to the introduction of sips of water and a soft diet. The study included 138 patients who received antibiotics and 59 who did not. After propensity score matching, 55 patients were assigned to each treatment group. There was no significant difference between the two groups in terms of age (p = 0.772), sex (p>0.999), body mass index (p = 0.121), prehospital symptom duration (p = 0.727), initial body temperature (p = 0.661), white blood cell count (p = 0.688), or C-reactive protein level (p = 0.337). There was also no statistically significant difference in the length of hospital stay between the no antibiotic and antibiotic groups (3.1±0.7 days vs. 3.0±1.0 days, p = 0.584). Additionally, no significant difference was observed between the no antibiotic and antibiotic groups with respect to time to sips of water (2.1±0.7 days vs. 1.8±0.9 days, p = 0.100) and time to the introduction of a soft diet (2.4±0.8 days vs. 2.1±0.9 days, p = 0.125). The findings suggest that routine antibiotics may be not required for treating patients with uncomplicated right colonic diverticulitis.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study

Lee

Park

et al. 2021

PLoS ONE

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“…Although previous studies have shown that the percentage of complications requiring surgery is higher in patients with ALCD than in patients with ARCD [ 163 ], the principles of diagnosis and treatment of ARCD are very similar to those of ALCD. As a treatment option, non-operative methods should be preferred in cases without diffuse peritonitis, although differentiating benign and malignant cases pre-operatively is often difficult [ 164 ]. Surgical treatment is usually used in the management of complicated cases [ 165 , 166 ].…”

Section: Acute Right Colonic Diverticulitismentioning

confidence: 99%

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Sartelli

Coccolini²,

Kluger

et al. 2021

World J Emerg Surg

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Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

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“…There is strong evidence to support non-operative management of right-sided AD. 24,25 However, patients are frequently misdiagnosed as having acute appendicitis, leading to unnecessary surgery. 17,26 In regions with a high incidence of right-sided AD, patients with right lower quadrant pain may be more likely to have preoperative imaging, due to diagnostic uncertainty.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

Turner

O’Grady

Senadeera

et al. 2021

ANZ Journal of Surgery

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Background: Once considered to be a congenital condition, the epidemiology of rightsided colonic diverticulosis (RCD) is evolving. Acute diverticulitis (AD) is a complication of RCD which is frequently misdiagnosed as appendicitis, resulting in unnecessary surgery, as there is strong evidence supporting medical management for right-sided AD. In general, the incidence of AD correlates with the prevalence of RCD, which shows marked geographic variation. Few data reporting RCD prevalence come from Western countries, so the aim of this study is to define the prevalence of RCD in a New Zealand population. Methods: Independent review of the imaging from 1000 consecutive patients undergoing a computed tomography Kidney/Ureter/Bladder scan for suspected urolithiasis at Christchurch Hospital between January and November 2017 was undertaken, to determine the presence or absence, and distribution of colonic diverticulosis. Patients were excluded if they had a history of colonic resection, known IBD, or were less than 18-years old.Results: Thirty-one patients were excluded, leaving 969 eligible patients. Overall, 95 patients (9.8%) had RCD identified. The prevalence of RCD increased significantly with advancing age, being present in 2.3% of those aged 18-29, increasing to 20.3% in those greater than 70-years old (p < 0.001). Conclusion:The prevalence of RCD in a New Zealand population is relatively high and increases significantly with age. This adds support to the role of cross-sectional imaging in the evaluation of suspected appendicitis, to exclude right-sided AD. The association with advancing age supports RCD being an acquired condition rather than a congenital condition as was previously thought.

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Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics

Cited by 23 publications

References 37 publications

Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study

Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

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