Traditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking.
Recently, 2 randomized clinical trials (AVOD trial and DIABOLO trial) published short-term results of omitting antibiotics compared to routine antibiotic treatment.
Both showed no significant differences regarding recovery from the initial episode, as well as rates of complicated or recurrent diverticulitis and sigmoid resection.
However, both studies showed a trend of higher rates of sigmoid resection in the observational groups.
Dr van Dijk and colleagues assessed the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis.
|Young patients were at risk for complicated or recurrent diverticulitis |
|Alimentary Pharmacology & Therapeutics|
A total of 528 patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomized to either an observational or an antibiotic treatment strategy (DIABOLO trial).
Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months’ follow up.
Differences between the groups were explored and risk factors were identified using multivariable logistic regression.
The team showed no difference in rates of recurrent diverticulitis, complicated diverticulitis and sigmoid resection.
The research team found that young patients and patients with a pain score at presentation of 8 or higher on a visual analogue pain scale were at risk for complicated or recurrent diverticulitis.
The team observed that treatment type was not an independent predictor for complicated or recurrent diverticulitis.
Dr van Dijk's team concludes, "Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up."
"As the DIABOLO trial was not powered for these secondary outcome measures, some uncertainty remains whether (small) non-significant differences could be true associations."