Madhav Desai1, Jihan Fathallah1, Venkat Nutalapati1, Shreyas Saligram2. 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.
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.
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.
Authors: Najia Azhar; Hager Aref; Adam Brorsson; Marie-Louise Lydrup; Fredrik Jörgren; Johannes Kurt Schultz; Pamela Buchwald Journal: BMC Emerg Med Date: 2022-02-21
Authors: Moon Young Oh; Rumi Shin; Seung Chul Heo; Han-Ki Lim; Min Jung Kim; Ji Won Park; Seung-Bum Ryoo; Seung-Yong Jeong; Kyu Joo Park Journal: Ann Med Surg (Lond) Date: 2022-08-18