Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics: A Systematic Review and Meta-analysis

被引:44
作者
Au, Stephanie [1 ]
Aly, Emad H. [2 ]
机构
[1] Western Gen Hosp, Dept Colorectal Surg, Edinburgh, Midlothian, Scotland
[2] Univ Aberdeen, Aberdeen, Scotland
关键词
Antibiotics; Colorectal surgery; Conservative management; Diverticulitis; RANDOMIZED CLINICAL-TRIAL; COLONIC DIVERTICULITIS; SIGMOID DIVERTICULITIS; PRACTICE PARAMETERS; NO ANTIBIOTICS; DISEASE; MANAGEMENT; RISK; SURGERY; DIET;
D O I
10.1097/DCR.0000000000001330
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND: Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment of uncomplicated acute diverticulitis. Recent studies have shown that treatment without antibiotics did not prolong recovery. Some new guidelines currently recommend selective use of antibiotics. OBJECTIVE: The purpose of this study was to compare the safety, effectiveness, and outcomes in treating uncomplicated acute diverticulitis without antibiotics with treatment with antibiotics. DATA SOURCES: PubMed, Embase, , and the Cochrane Library were searched with the key words antibiotics and diverticulitis. STUDY SELECTION: All studies published in English on treating uncomplicated acute diverticulitis without antibiotics and containing >20 individuals were included. INTERVENTION: Treatment without antibiotics versus treatment with antibiotics were compared. MAIN OUTCOME MEASURES: The primary outcome was the percentage of patients requiring additional treatment or intervention to settle during the initial episode. The secondary outcomes were duration of hospital stay, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, and complication. RESULTS: Search yielded 1164 studies. Nine studies were eligible and included in the meta-analysis, composed of 2505 patients, including 1663 treated without antibiotics and 842 treated with an antibiotic. The no-antibiotics group had a significantly shorter hospital stay (mean difference = -0.68; p = 0.04). There was no significant difference in the percentage of patients requiring additional treatment or intervention to settle during the initial episode (5.3% vs 3.6%; risk ratio = 1.48; p = 0.28), rate of readmission or deferred admission (risk ratio = 1.17; p = 0.26), need for surgical or radiological intervention (risk ratio = 0.61; p = 0.34), recurrence (risk ratio = 0.83; p = 0.21), and complications (risk ratio = 0.70-1.18; p = 0.67-0.91). LIMITATIONS: Only a limited number of studies were available, and they were of variable qualities. CONCLUSIONS: Treatment of uncomplicated acute diverticulitis without antibiotics is associated with a significantly shorter hospital stay. There is no significant difference in the percentage of patients requiring additional treatment or intervention to settle in the initial episode, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, or complications.
引用
收藏
页码:1533 / 1547
页数:15
相关论文
共 35 条
[1]   A PROSPECTIVE-STUDY OF DIET AND THE RISK OF SYMPTOMATIC DIVERTICULAR-DISEASE IN MEN [J].
ALDOORI, WH ;
GIOVANNUCCI, EL ;
RIMM, EB ;
WING, AL ;
TRICHOPOULOS, DV ;
WILLETT, WC .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 1994, 60 (05) :757-764
[2]   Colonic diverticulitis: impact of imaging on surgical management - a prospective study of 542 patients [J].
Ambrosetti, P ;
Becker, C ;
Terrier, F .
EUROPEAN RADIOLOGY, 2002, 12 (05) :1145-1149
[3]  
Andersen JC, 2012, DAN MED J, V59
[4]   Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis [J].
Andeweg, Caroline S. ;
Mulder, Irene M. ;
Felt-Bersma, Richelle J. F. ;
Verbon, Annelies ;
van der Wilt, Gert Jan ;
van Goor, Harry ;
Lange, Johan F. ;
Stoker, Jaap ;
Boermeester, Marja A. ;
Bleichrodt, Robert P. .
DIGESTIVE SURGERY, 2013, 30 (4-6) :278-292
[5]  
Association of Coloproctology of Great Britain and Ireland, COMM GUID COL DIV DI
[6]  
Beckham Heath, 2009, Clin Colon Rectal Surg, V22, P156, DOI 10.1055/s-0029-1236159
[7]   Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines [J].
Binda, G. A. ;
Cuomo, R. ;
Laghi, A. ;
Nascimbeni, R. ;
Serventi, A. ;
Bellini, D. ;
Gervaz, P. ;
Annibale, B. .
TECHNIQUES IN COLOPROCTOLOGY, 2015, 19 (10) :615-626
[8]   Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study [J].
Brochmann, N. D. ;
Schultz, J. K. ;
Jakobsen, G. S. ;
Oresland, T. .
COLORECTAL DISEASE, 2016, 18 (11) :1101-1107
[9]   Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis [J].
Chabok, A. ;
Pahlman, L. ;
Hjern, F. ;
Haapaniemi, S. ;
Smedh, K. .
BRITISH JOURNAL OF SURGERY, 2012, 99 (04) :532-539
[10]   Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians [J].
Crowe, Francesca L. ;
Appleby, Paul N. ;
Allen, Naomi E. ;
Key, Timothy J. .
BMJ-BRITISH MEDICAL JOURNAL, 2011, 343