MedWire News: Antibiotic treatment for acute uncomplicated diverticulitis fails to accelerate recovery or prevent complications or recurrence, shows research.
"Antibiotics have been used in the treatment of uncomplicated diverticulitis since their introduction, as the condition has been suggested to be caused by bacterial infection. Despite the lack of controlled studies and previously demonstrated disease resolution without antibiotic treatment, treatment with antibiotics has become the standard of care for uncomplicated diverticulitis," explain the study authors, led by Kenneth Smedh (Central Hospital, Västerås, Sweden).
"Some authors, however, have suggested that diverticulitis could be a form of inflammatory bowel disease."
Their study, published in the British Journal of Surgery, investigated whether antibiotic treatment was needed in acute uncomplicated diverticulitis cases. The recruited patients were randomly assigned to receive treatment with or without antibiotics, and were followed up at 12 months. The median age of the patients was 58 years.
All patients had a history of acute abdominal pain and fever, and at admission the patient groups reported similar symptoms. There were no significant differences in age, gender, body mass index, comorbidity and inflammatory parameters, C-reactive protein level, and body temperature between the two groups.
A total of 582 patients were included in the final analysis after follow-up; 292 patients who received antibiotic treatment and 290 who did not.
There were no significant differences between the groups in terms of complications such as perforation or abscess formation; complications were found in three (1.0%) patients in the antibiotics-treated group and six (1.9%) patients in the no antibiotics-treated group. Median hospital stay was 3 days in both groups.
The number of patients with recurrent diverticulitis that required readmission to hospital within a year was also similar between the groups; 15.8% in the antibiotics group, and 16.2% in the no antibiotics group.
"From these results it may be postulated that antibiotic treatment of acute uncomplicated diverticulitis does not prevent complications, accelerate recovery or prevent recurrence," write Smedh and colleagues.
Treatment with antibiotics for acute uncomplicated diverticulitis is "based on tradition and expert opinions, and not on evidence derived from controlled trials," they add.
The researchers stress that as antibiotic resistance is an "escalating problem" among bowel pathogens, antibiotic use should be optimized.
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