SP3.1.2 Antibiotics therapy may not be required in patients with CT proven uncomplicated acute diverticulitis: A systematic review. (9th August 2022)

• Record Type: Journal Article
• Authors: Imsirovic, Anja; Peristeri, Dimitra V; Nour, Hussameldin M; Swaminathan, Christie; Sajid, Muhammad S
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac247.030
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aims: Acute diverticulitis (AD) is one of the major acute surgical conditions which need either hospital admission or a dedicated ambulatory care services in order to provide conventional antibiotics therapy. Regular use of antibiotics for all cases of acute diverticulitis has recently been challenged. The aim is to evaluate the necessity of antibiotics in patients presenting with CT proven uncomplicated AD. Method: A systematic search was undertaken and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes, including failure to response to intervention, recurrence rates and surgery during the acute admission, were analyzed using the principles of meta-analysis on RevMan 5 statistical software. Result: Four RCTs on 1756 patients who presented with CT-proven uncomplicated diverticulitis were included in this review. There were 879 patients in the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). The failure to response to intervention (use of intravenous antibiotics) was not statistically significant between the two groups, however slight statistical favour was observed in AG [OR 0.49, 95% CI (0.22–1.06), z=1.81, p=0.07]. There was no statistical difference related to recurrence rates of acute diverticulitis between the two groups. Finally, the need of surgical intervention following both interventions was also statistically similar [OR 0.63, 95% CI (0.29–1.36), z=1.18, p=0.24]. Conclusion: The use of antibiotics in patients with CT proven uncomplicated AD does not seem to improve the short-term outcomes; therefore it can be carefully omitted in selected patients. More RCTs of robust quality are required to validate these findings.