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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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

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: mdesai@kumc.edu

© 2019 The American Society of Colon and Rectal Surgeons