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Am. J. Gastroenterol. · Jul 2018
Randomized Controlled Trial Multicenter StudyLong-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis.
- S T van Dijk, L Daniels, Ç Ünlü, N de Korte, S van Dieren, H B Stockmann, B C Vrouenraets, E C Consten, J A van der Hoeven, Q A Eijsbouts, I F Faneyte, W A Bemelman, M G Dijkgraaf, M A Boermeester, and Dutch Diverticular Disease (3D) Collaborative Study Group.
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands.
- Am. J. Gastroenterol. 2018 Jul 1; 113 (7): 1045-1052.
BackgroundTraditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking. Recently, two 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. Here, the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis were assessed.MethodsA 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.ResultsComplete case analyses showed no difference in rates of recurrent diverticulitis (15.4% in the observational group versus 14.9% in the antibiotic group; p = 0.885), complicated diverticulitis (4.8% versus 3.3%; p = 0.403) and sigmoid resection (9.0% versus. 5.0%; p = 0.085). Young patients (<50 years) 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. In this multivariable analysis, treatment type (with or without antibiotics) was not an independent predictor for complicated or recurrent diverticulitis.ConclusionOmitting 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.
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