Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis
Chabok, Abbas, et al. “Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis.” British journal of surgery 99.4 (2012): 532-539.
The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. Some have suggested that diverticulitis could be a form of inflammatory bowel disease, which questions the rationale behind prescribing antibiotics for the treatment of uncomplicated diverticulitis. The aim of the study was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis.
This was an open multicenter RCT that ran between October 2003 and January 2010 with the participation of ten surgical departments in Sweden and one in Iceland. Patients aged over 18 years with acute uncomplicated left-sided diverticulitis were eligible. Uncomplicated diverticulitis was defined as an episode with history and signs of diverticulitis, without sepsis, verified by CT, and without any sign of complications such as abscess, free air or fistula. Patients were randomized to treatment with IV fluids only or in combination with antibiotic therapy. At 6–8 weeks after discharge, patients had a colonic investigation by colonoscopy, barium enema or CT. After 12 months, patients were contacted to complete a questionnaire.
623 patients with CT verified acute uncomplicated diverticulitis were enrolled in the study: 309 patients in the no-antibiotics and 314 in the antibiotics group. Nine patients suffered from complications, six with sigmoid perforation and three with abscess formation. In the no-antibiotics group, three had perforations and three developed abscesses. In the antibiotics group, three patients had perforations. At 12 months, of those 623 patients, 41 were lost to follow-up. Recurrent diverticulitis occurred in 93 of the remaining 582 patients during follow-up, with no significant difference between the two groups.
This study evaluated the need for antibiotic treatment in acute uncomplicated diverticulitis. It showed that antibiotic therapy does not prevent surgical complications or recurrence, and does not shorten hospital stay. Previous RCT’s have only suggested a non-inferiority between different antibiotic regimes and treatment lengths. This new evidence needs confirmation from more RCT’s before it can be implicated safely in clinical guidelines. Furthermore, the role of antibiotics in the treatment of complicated diverticulitis has not been investigated yet.