Level 1a Evidence Comparing Use of Antibiotics Versus No Antibiotics in Management of Acute Left-Sided Uncomplicated Diverticulitis.

Sokhal, Balamrit Singh; Mostafa, Omar Ezzat Saber; Ramasamy, Sadhasivam; Spyridon, Roditis; Zaman, Shafquat; Hajibandeh, Shahab; Hajibandeh, Shahin

Abstract

Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This meta-analysis aimed to compare the effectiveness of no antibiotics vs antibiotics in AUD patients. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomized controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modeling with 95% confidence intervals (CIs). 5 RCTs with 1934 AUD patients were included. 979 patients were managed without antibiotics (50.6%). Patients in the no antibiotic and antibiotic groups had comparable demographics (age, sex, and body mass index) and presenting features (temperature, pain score, and C-reactive protein levels). There was no significant difference in rates of complicated diverticulitis (OR: .61, 95% CI: 0.27-1.36, = .23), abscess (OR: .51, 95% CI: .08-3.25, = .47) or fistula (OR: .33, 95% CI: .03-3.15, = .33) formation, perforation (OR: .98, 95% CI: .32-3.07, = .98), recurrence (OR: .96, 95% CI: .66-1.41, = .85), need for surgery (OR: 1.36, 95% CI: .47-3.95, = .37), mortality (OR: 1.27, 95% CI: .14-11.76, = .82), or length of stay (MD: .215, 95% CI: -.43-.73, = .61) between the 2 groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, = .0002). There is no significant difference in baseline characteristics, clinical presentation, and adverse health outcomes between AUD patients treated without antibiotics compared to with antibiotics.

Citation

Sokhal, B. S., Mostafa, O. E. S., Ramasamy, S., Spyridon, R., Zaman, S., Hajibandeh, S., & Hajibandeh, S. (in press). Level 1a Evidence Comparing Use of Antibiotics Versus No Antibiotics in Management of Acute Left-Sided Uncomplicated Diverticulitis. The American Surgeon, https://doi.org/10.1177/00031348241227183

• Journal Article Type: Article
• Acceptance Date: Jan 11, 2024
• Online Publication Date: Jan 11, 2024
• Deposit Date: Jan 29, 2024
• Journal: The American surgeon
• Print ISSN: 0003-1348
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/00031348241227183
• Keywords: meta-analysis, antibiotics, diverticulitis, outcomes