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

Stephanie Au* (Corresponding Author), Emad H Aly

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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, Clinicaltrials.gov, 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.

Original languageEnglish
Pages (from-to)1533-1547
Number of pages15
JournalDiseases of the Colon & Rectum
Volume62
Issue number12
Early online date17 Jan 2019
DOIs
Publication statusPublished - Dec 2019
EventMeeting of European Society of Coloproctology - Nice, France
Duration: 26 Sep 201828 Sep 2018

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Diverticulitis
Meta-Analysis
Anti-Bacterial Agents
Odds Ratio
Therapeutics
Length of Stay
Recurrence
Ireland
PubMed
Libraries

Keywords

  • antibiotics
  • colorectal surgery
  • conservative management
  • diverticulitis

Cite this

Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics : A Systematic Review and Meta-Analysis. / Au, Stephanie (Corresponding Author); Aly, Emad H.

In: Diseases of the Colon & Rectum, Vol. 62, No. 12, 12.2019, p. 1533-1547.

Research output: Contribution to journalArticle

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title = "Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics: A Systematic Review and Meta-Analysis",
abstract = "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, Clinicaltrials.gov, 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.",
keywords = "antibiotics, colorectal surgery, conservative management, diverticulitis",
author = "Stephanie Au and Aly, {Emad H}",
note = "ACKNOWLEDGMENT We thank Kenneth McLean, statistics tutor in the Edinburgh Surgical Sciences Qualification program of University of Edinburgh, for his help in statistics.",
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T1 - Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics

T2 - A Systematic Review and Meta-Analysis

AU - Au, Stephanie

AU - Aly, Emad H

N1 - ACKNOWLEDGMENT We thank Kenneth McLean, statistics tutor in the Edinburgh Surgical Sciences Qualification program of University of Edinburgh, for his help in statistics.

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N2 - 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, Clinicaltrials.gov, 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.

AB - 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, Clinicaltrials.gov, 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.

KW - antibiotics

KW - colorectal surgery

KW - conservative management

KW - diverticulitis

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DO - 10.1097/DCR.0000000000001330

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C2 - 30663999

VL - 62

SP - 1533

EP - 1547

JO - Diseases of the Colon & Rectum

JF - Diseases of the Colon & Rectum

SN - 0012-3706

IS - 12

ER -