Medicine by the Numbers

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Antibiotics for Uncomplicated Diverticulitis

 

Am Fam Physician. 2020 Dec 1;102(11):online.

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ANTIBIOTICS FOR UNCOMPLICATED DIVERTICULITIS

BenefitsHarms

1 in 32 had a lower risk of treatment failure (defined as deterioration prompting initial or expanded antibiotic treatment)

1 in 24 had a higher risk of antibiotic-related morbidity or adverse reaction

ANTIBIOTICS FOR UNCOMPLICATED DIVERTICULITIS

BenefitsHarms

1 in 32 had a lower risk of treatment failure (defined as deterioration prompting initial or expanded antibiotic treatment)

1 in 24 had a higher risk of antibiotic-related morbidity or adverse reaction

Details for This Review

Study Population: 1,151 patients with pericolonic abscesses

Efficacy End Points: Requiring additional treatment or intervention during initial episode

Harm End Points: Antibiotic-related morbidity

Narrative: Each year in the United States, there are more than 2.6 million outpatient visits and 200,000 inpatient admissions for diverticulitis.1 Diverticulitis can be divided into uncomplicated and complicated forms. Complicated diverticulitis is associated with abscess formation, fistula, and bowel obstruction or perforation. Approximately 5% to 15% of patients with diverticulitis develop an abscess or fistula, whereas bowel obstruction and frank perforation are rare.2 The mainstay of treatment for uncomplicated diverticulitis has been antibiotic therapy with bowel rest. However, recent studies have questioned the role of antibiotics.3,4 Systematic reviews have examined outcomes of acute uncomplicated diverticulitis treated with or without antibiotics.58

The reviews included randomized trials and observational studies. Because of the high risk of bias and confounding in observational studies, only results from the two randomized trials were considered.3,4 End points included treatment failure, recurrence of diverticulitis, complications, readmission, and mortality. Follow-up was at one month and 50 months, respectively.3,4

The difference between groups was not significant for any major end points, including recurrence rate (56 of 571 patients in the nonantibiotic group vs. 54 of 580 patients in the antibiotic group, P = .77, respectively), complications (18 of

Author disclosure: No relevant financial affiliations.


Copyright © 2020 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

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1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179–1187.e3....

2. Linzay CD, Pandit S. Acute diverticulitis [Updated August 10, 2020]. In: StatPearls. Treasure Island: StatPearls Publishing; January 2020. Accessed September 10, 2020. https://www.ncbi.nlm.nih.gov/books/NBK459316/

3. Chabok A, Påhlman L, Hjern F, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99(4):532–539.

4. Daniels L, Ünlü Ç, de korte N, et al.; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104(1):52–61.

5. Emile SH, Elfeki H, Sakr A, et al. Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure. Tech Coloproctol. 2018;22(7):499–509.

6. Tandon A, Fretwell VL, Nunes QM, et al. Antibiotics versus no antibiotics in the treatment of acute uncomplicated diverticulitis—a systematic review and meta-analysis [published online January 11, 2018]. Colorectal Dis. Accessed September 10, 2020. https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.14013

7. Desai M, Fathallah J, Nutalapati V, et al. Antibiotics versus no antibiotics for acute uncomplicated diverticulitis: a systematic review and meta-analysis. Dis Colon Rectum. 2019;62(8):1005–1012.

8. Au S, Aly EH. Treatment of uncomplicated acute diverticulitis without antibiotics: a systematic review and meta-analysis. Dis Colon Rectum. 2019;62(12):1533–1547.

 

 

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