Antibiotics Versus No Antibiotics for Acute Uncomplicated Diverticulitis: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Antibiotics are routinely used for diverticulitis irrespective of severity. Current practice guidelines favor against the use of antibiotics for acute uncomplicated diverticulitis. OBJECTIVE: We performed a systematic review and meta-analysis to examine the role of antibiotic use in an episode of uncomplicated diverticulitis. DATA SOURCES: PubMed/Medline, Embase, Scopus, and Cochrane were used. STUDY SELECTION: Eligible studies included those with patients with uncomplicated diverticulitis receiving any antibiotics compared with patients not receiving any antibiotics (or observed alone). MAIN OUTCOME MEASURES: Pooled odds rate of total complications, treatment failure, recurrent diverticulitis, readmission rate, sigmoid resection, mortality rate, and length of stay were measured. RESULTS: Of 1050 citations reviewed, 7 studies were eligible for the analysis. There were total of 2241 patients: 895 received antibiotics (mean age = 59.1 y; 38% men) and 1346 did not receive antibiotics (mean age = 59.4 y; 37% men). Antibiotics were later added in 2.7% patients who initially were observed off antibiotics. Length of hospital stay was not significantly different among either group (no antibiotics = 3.1 d vs antibiotics = 4.5 d; p = 0.20). Pooled rate of recurrent diverticulitis was not significantly different among both groups (pooled OR = 1.27 (95%, CI 0.90–1.79); p = 0.18). Rate of total complications (pooled OR = 1.99 (95% CI, 0.66–6.01); p = 0.22), treatment failure (pooled OR = 0.68 (95% CI, 0.42–1.09); p = 0.11), readmissions (pooled OR = 0.75 (95% CI, 0.44–1.30); p = 0.31). and patients who required sigmoid resection (pooled OR = 3.37 (95% CI, 0.65–17.34); p = 0.15) were not significantly different among patients who received antibiotics and those who did not. Mortality rates were 4 of 1310 (no-antibiotic group) versus 4 of 863 (antibiotic group). LIMITATIONS: Only 2 randomized controlled studies were available and there was high heterogeneity in existing data. CONCLUSIONS: This meta-analysis of current literature shows that patients with uncomplicated diverticulitis can be monitored off antibiotics.

Colonic diverticular disease

“…]in patients with uncomplicated diverticulitis. Five meta-analyses (including RCTs, cohort studies and case-control studies)[174][175][176][177][178] [Au: removed information on publication year for brevity] demonstrated that clinical outcomes between patients treated with and those treated without antimicrobials are not substantially different. Indeed, no substantial differences were evident in the proportion of patients requiring additional treatment or intervention, rate of readmission or deferred admission, need for surgical or radiological intervention, and recurrence or complication rate.…”

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

“…The first statements are dedicated to the current indication on antibiotic of in the setting of AD. The first claims that the management of acute diverticulitis without antibiotics does not increase these worse outcomes [63][64][65][66][67][68]. Therefore, the second statement confirms that antibiotics have to be used by a "case-by-case" basis [5,66], and that some parameters (namely levels of PCR and CT findings at entry) may be predictive on the need to use antibiotics in this population (48,66).…”

Management of acute diverticulitis in Covid 19 times. Our experience.

“…92'9 % of the patients in 2019 were classified as Hinchey I It is a disease that can range from mild to potentially severe, depending on which its treatment may vary. For a long time, antibiotic treatment has been the treatment of choice for mild acute diverticulitis; however, some studies have shown that dietary changes alone can resolve it p [8,9]. In our study, we can observe how the number of consultations of mild patients decreased without a very significant increase in the number of consultations of severe cases.…”