Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis - a systematic review and meta-analysis

AimAcute uncomplicated diverticulitis (AUD) is common and antibiotics are the cornerstone of traditional conservative management. This approach lacks a clear evidence base and studies have recently suggested that avoidance of antibiotics is a safe and efficacious way to manage AUD. The aim of this systematic review is to determine the safety and efficacy of treating AUD without antibiotics. MethodA systematic search of Embase, Cochrane Library, MEDLINE, Science Citation Index Expanded and ClinicalTrials.gov was performed. Studies comparing antibiotics vs no antibiotics in the treatment of AUD were included. Meta-analysis was performed using the random effects model with the primary outcome measure being diverticulitis-associated complications. Secondary outcomes were readmission rate, diverticulitis recurrence, mean hospital stay, requirement for surgery and requirement for percutaneous drainage. ResultsEight studies were included involving 2469 patients: 1626 in the non-antibiotic group (NAb) and 843 in the antibiotic group (Ab). There was a higher complication rate in the Ab group; however, this was not significant (1.9% vs 2.6%) with a combined risk ratio of 0.63 (95% CI 0.25-1.57, P=0.32). There was a shorter mean length of hospital stay in the NAb group (standard mean difference -1.18 (95% CI -2.34 to -0.03, P=0.04). There was no significant difference in readmission, recurrence and surgical intervention rate or requirement for percutaneous drainage. ConclusionTreatment of AUD without antibiotics may be feasible with outcomes that are comparable to antibiotic treatment and with potential benefits for patients and the National Health Service. Large scale randomized multicentre studies are needed.