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Antibiotics Versus No Antibiotics for Acute Uncomplicated Diverticulitis

A Systematic Review and Meta-analysis

Desai, Madhav M.D., M.P.H.1; Fathallah, Jihan M.D.1; Nutalapati, Venkat M.D.1; Saligram, Shreyas M.D., M.R.C.P.2

doi: 10.1097/DCR.0000000000001324
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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.

1 Division of Gastroenterology and Hepatology, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas

2 Department of Gastroenterology and Hepatology, University of California San Francisco Fresno and VA Medical Center Fresno, Fresno, California

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Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Madhav Desai, M.D., M.P.H., Gastroenterology and Hepatology, 3901 Rainbow Blvd, Kansas City, KS 66160. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons