Systematic Review
Volume 8 Issue 4 - 2021
Does Antibiotics have a Role in the Treatment of Acute Uncomplicated Diverticulitis? A Systematic Review and Meta-Analysis
Ahmad Arsalan Tahir1*, Kiren Ali2, Aswad U Khan3, Sahifa Kamal4, Anwar Hussain5 and Arif U Khan5
1General Surgery, University Hospital of North Midlands, Stoke on Trent, UK
2General Surgery, Wishaw General Hospital, Wishaw, UK
3General Surgery, Medical University of Pleven, Pleven, Bulgaria
4General Surgery, Pak International Medical College, Peshawar, Pakistan
5General Surgery, Mid Cheshire NHS Foundation Trust, Crewe, UK
*Corresponding Author: Ahmad Arsalan Tahir, General Surgery, University Hospital of North Midlands, Stoke on Trent, UK.
Received: February 22, 2021; Published: March 15, 2021




Abstract

Introduction: Diverticular disease is a common health problem and is associated with high morbidity and economic costs. The clinical spectrum can range from asymptomatic diverticulosis to varying severity of sepsis. About 75% of the patients would have uncomplicated diverticulitis and the condition is treated with antibiotics, analgesia and dietary advice. Recent evidence has shown that the treatment of uncomplicated diverticulitis is controversial and questioning the use of antibiotics. This study aims to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis.

Methods: This is a systematic review and Meta-analysis. A literature review of the available studies was conducted using online search engines like Pubmed, Medline, Embase, Google Scholar and Cochrane databases. Statistical analysis was conducted using RevMan 5.4.

Results: 1754 records identified. 1324 were duplicates, remaining 430 studies were screened for inclusion. 395 studies were further excluded. 35 full text articles were assessed for eligibility and in the final review 10 studies were included. PRISMA guidelines were used for this study. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay = -0.66 (95% CI = -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure = 1.24 (95% CI = 0.90 - 1.69).

Conclusion: We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure and duration of hospital stay in acute uncomplicated diverticulitis. However, risk stratification is required for the selected cases that might benefit from antibiotic use.

 

Keywords: Diverticulosis; Antibiotics; Acute Uncomplicated Diverticulitis; Colonic Diverticulosis

References

  1. Swanson SM and Strate LL. “In the Clinic: Acute Colonic Diverticulitis”. Annals of Internal Medicine 168 (2018): ITC65-ITC80.
  2. Schein M and Paladugn R. “Diverticulitis, Surgical Treatment: Evidence-Based and Problem-Oriented”. Zuckschwerdt (2001).
  3. Painter NS and Burkitt DP. “Diverticular disease of the colon, a 20th century problem”. Journal of Clinical Gastroenterology 4 (1975): 3-21.
  4. Lo CY and Chu KW. “Acute diverticulitis of the right colon”. The American Journal of Surgery 171 (1996): 244-246.
  5. Ferzoco LB., et al. “Acute diverticulitis”. The New England Journal of Medicine 338 (1998): 1521-1526.
  6. Klarenbeek BR., et al. “Review of current classifications for diverticular disease and a translation into clinical practice”. The International Journal of Colorectal Disease 27 (2012): 207-214.
  7. Wilkins T., et al. “Diagnosis and Management of Acute Diverticulitis”. AFP 87 (2013): 612-620.
  8. Stollman NH and Raskin JB. “Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology”. The American Journal of Gastroenterology 94 (1999): 3110-3121.
  9. Laméris W., et al. “A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department”. Diseases of the Colon and Rectum 53 (2010): 896-904.
  10. Jacobs DO. “Clinical practice. Diverticulitis”. The New England Journal of Medicine 357 (2007): 2057-2066.
  11. Association of Coloproctology of Great Britain and Ireland. Commissioning guide: colonic diverticular disease (2017).
  12. Chabok A., et al. “Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis”. BJS British Journal of Surgery 99 (2012): 532-539.
  13. Daniels L., et al. “Dutch Diverticular Disease (3D) Collaborative Study Group, 2017. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis”. British Journal of Surgery 104 (2017): 52-61.
  14. Andersen JC., et al. “Danish national guidelines for treatment of diverticular disease”. Danish Medical Journal 59 (2012): C4453.
  15. Andeweg CS., et al. “Netherlands Society of Surgery, Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians, 2013. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis”. Digestive Surgery 30 (2013): 278-292.
  16. Binda GA., et al. “Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines”. Techniques in Coloproctology 19 (2015): 615-626.
  17. Moher D., et al. “Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement”. Systematic Reviews 4 (2015): 1.
  18. Isacson D., et al. “Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis”. BJS British Journal of Surgery 106 (2019): 1542-1548.
  19. Dijk S Van., et al. “Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis”. American Journal of Gastroenterology 113 (2018): 1045-1052.
  20. Hjern F., et al. “Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory?” Scandinavian Journal of Gastroenterology 42 (2007): 41-47.
  21. De Korte, N., et al. “Mild colonic diverticulitis can be treated without antibiotics. A case-control study”. Colorectal Disease 14 (2012): 325-330.
  22. Isacson D., et al. “No antibiotics in acute uncomplicated diverticulitis: does it work?” Scandinavian Journal of Gastroenterology 49 (2014): 1441-1446.
  23. Mali JP., et al. “Symptomatic Treatment for Uncomplicated Acute Diverticulitis: A Prospective Cohort Study”. Diseases of the Colon and Rectum 59 (2016): 529-534.
  24. Brochmann ND., et al. “Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study”. Colorectal Disease 18 (2016): 1101-1107.
  25. Isacson, D., et al. “Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study”. The International Journal of Colorectal Disease 30 (2015): 1229-1234.
  26. Weizman AV and Nguyen GC. “Diverticular disease: Epidemiology and management”. Canadian Journal of Gastroenterology 25 (2011): 385-389.
  27. Detry R., et al. “Acute localized diverticulitis: Optimum management requires accurate staging”. The International Journal of Colorectal Disease 7 (1992): 38-42.
  28. Floch MH. “A Hypothesis: Is Diverticulitis a Type of Inflammatory Bowel Disease?” Journal of Clinical Gastroenterology 40 (2006): S121.
  29. Shabanzadeh DM and Wille-Jørgensen P. “Antibiotics for uncomplicated diverticulitis”. Cochrane Database of Systematic Reviews 11 (2012): CD009092.
  30. Bolkenstein H., et al. “Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure”. The International Journal of Colorectal Disease 33 (2018): 863-869.
  31. Mora Lopez L., et al. “The Diverticulitis Study Group, Multicentre, controlled, randomized clinical trial to compare the efficacy and safety of ambulatory treatment of mild acute diverticulitis without antibiotics with the standard treatment with antibiotics”. The International Journal of Colorectal Disease 32 (2017): 1509-1516.
Citation: Ahmad Arsalan Tahir., et al. “Does Antibiotics have a Role in the Treatment of Acute Uncomplicated Diverticulitis? A Systematic Review and Meta-Analysis”. EC Gastroenterology and Digestive System 8.4 (2021): 49-58.

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