Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis13

Chabok, Abbas; Påhlman, Lars; Hjern, Fredrik; Haapaniemi, Staffan; Smedh, K.

doi:10.1002/bjs.8688

Cited by 443 publications

(344 citation statements)

References 16 publications

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“…При невыраженной клинической симптоматике и доста-точной уверенности в отсутствии более тяжелых ослож-нений антибактериальные препараты можно не назна-чать (УД-1b; CP-A) [9,27,28].…”

Section: острый неосложненный дивертикулитunclassified

Diverticular Disease of the Colon: Resolved and Unresolved Issues

Ардатская¹

2017

Med. sov.

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Статья посвящена вопросам классификации и лечения дивертикулярной болезни толстой кишки, которая по распростра-ненности, характеру клинических проявлений, наличию осложнений представляет не только медицинскую, но и огромную социально-экономическую проблему. В статье подробно изложены различные отечественные и зарубежные классификационные подходы с отражением досто-инств и издержек, требующих внесение соответствующих изменений в современные Российские рекомендации по диа-гностике и лечению взрослых больных дивертикулярной болезнью ободочной кишки для разработки характера лечебно-профилактических мероприятий при разных формах заболевания. Установлено место и дан анализ эффективности различных схем терапии с использованием рифаксимина-α (Альфа Нормикс), месалазина, пищевых волокон, в частности псиллиума, в терапии дивертикулярной болезни без клинических проявлений (бессимптомном дивертикулезе); ДБ с клиническими проявлениями, в т. ч. в рецидивирующей форме (симпто-матический неосложненный дивертикулез); при лечении острого неосложненного дивертикулита, а также для профилак-тики рецидивов острого дивертикулита (курсовое и перманентное лечение).

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Section: острый неосложненный дивертикулитunclassified

Diverticular Disease of the Colon: Resolved and Unresolved Issues

Ардатская¹

2017

Med. sov.

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“…37 These findings encouraged a randomised controlled trial of antibiotics in patients with acute uncomplicated acute diverticulitis from Sweden, which reported no difference in complications such as abscess or perforation between those treated with or without antibiotics with a median length of stay in both groups of 3 days. 63 This study, however, was criticised for excluding patients with sepsis (though no definition of sepsis was provided) and for problems with possible selection bias, given that not all patients eligible for the study were recorded. It remains to be seen if these results are generalisable.…”

Section: Conservative/medicalmentioning

confidence: 99%

Review article: the pathogenesis and management of acute colonic diverticulitis

Humes

Spiller

2014

Aliment Pharmacol Ther

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SummaryBackgroundAcute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years.AimTo review the current understanding of the aetiology and treatment of acute diverticulitis.MethodsA search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis.ResultsThere are 75 hospital admissions per year for acute diverticulitis per 100 000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7‐year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti‐inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in‐hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited.ConclusionsFurther high‐quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence‐based.

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“…These results should be interpreted with caution, as neither study was randomized, and the impact of selection bias on the outcomes must be considered. A recent Cochrane review concluded that there were no significant differences in outcomes whether or not antibiotics were given, although this was based on a single randomized controlled trial [20] and was accompanied by a recommendation that confirmation from further randomized trials should be obtained before incorporating these findings into clinical practice [15]. It appears that although this approach may not be appropriate for all patients, the potential for omitting antibiotics in selected patients with radiologically confirmed uncomplicated diverticulitis does exist.…”

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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Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis13

Abstract: Antibiotic treatment for acute uncomplicated diverticulitis neither accelerates recovery nor prevents complications or recurrence. It should be reserved for the treatment of complicated diverticulitis.

Cited by 443 publications

References 16 publications

Diverticular Disease of the Colon: Resolved and Unresolved Issues

Diverticular Disease of the Colon: Resolved and Unresolved Issues

Review article: the pathogenesis and management of acute colonic diverticulitis

Management of Acute Diverticulitis and its Complications

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