TY - JOUR
T1 - Antibiotics Versus No Antibiotics for Acute Uncomplicated Diverticulitis
T2 - A Systematic Review and Meta-analysis
AU - Desai, Madhav
AU - Fathallah, Jihan
AU - Nutalapati, Venkat
AU - Saligram, Shreyas
N1 - Publisher Copyright:
© The American Society of Colon & Rectal Surgeons, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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.
AB - 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.
KW - Antibiotics
KW - Diverticulitis
UR - http://www.scopus.com/inward/record.url?scp=85069292961&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069292961&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000001324
DO - 10.1097/DCR.0000000000001324
M3 - Review article
C2 - 30664553
AN - SCOPUS:85069292961
SN - 0012-3706
VL - 62
SP - 1005
EP - 1012
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 8
ER -