Do we really need Antibiotics for Simple Uncomplicated Diverticulitis? Results of Meta-Analysis of Randomised Controlled Trials.
Sokhal, Balamrit S Mostafa, Omar E S Ramasamy, Sadhasivam Spyridon, Roditis Hajibandeh, Shahab
Sokhal, Balamrit S
Mostafa, Omar E S
Ramasamy, Sadhasivam
Spyridon, Roditis
Hajibandeh, Shahab
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Affiliation
Keele University; The Dudley Group NHS Foundation Trust; Royal Stoke University Hospital
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Publication date
2024-10-07
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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 versus antibiotics in AUD patients. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomised controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modelling with 95% confidence intervals (CI). Five 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: 0.61, 95% CI :0.27-1.36, p=0.23), abscess (OR: 0.51, 95% CI: 0.08-3.25, p=0.47) or fistula (OR: 0.33, 95% CI: 0.03-3.15, p=0.33) formation, perforation (OR: 0.98, 95% CI: 0.32-3.07, p=0.98), recurrence (OR: 0.96, 95% CI: 0.66-1.41, p=0.85) need for surgery (OR: 1.36, 95% CI: 0.47-3.95, p=0.37), mortality (OR: 1.27, 95% CI: 0.14-11.76, p=0.82) or length of stay (MD: 0.215, 95% CI: -0.43-0.73, p=0.61) between the two groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, p=0.0002). 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
Balamrit Singh Sokhal, Omar Ezzat Saber Mostafa, Sadhasivam Ramasamy, Roditis Spyridon, Shahab Hajibandeh, Shahin Hajibandeh, FP2.13 - Do we really need Antibiotics for Simple Uncomplicated Diverticulitis? Results of Meta-Analysis of Randomised Controlled Trials,�British Journal of Surgery, Volume 111, Issue Supplement_8, September 2024, znae197.358,