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Observational treatment of uncomplicated acute diverticulitis not inferior to antibiotics

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An observational treatment strategy for uncomplicated acute diverticulitis did not result in short- or long-term repercussions compared with an antibiotic treatment strategy, according to data presented at UEG Week.

“An observational treatment strategy without antibiotics for a first episode of CT-proven uncomplicated acute diverticulitis is not inferior to an antibiotic treatment strategy with respect to the time-to-recovery,” Lidewine Daniels, surgery resident and PhD candidate from the Academic Medical Center at University of Amsterdam, told Healio Gastroenterology. “Furthermore, observation does not lead to higher rates of readmission, complicated, ongoing and recurrent diverticulitis and sigmoid resection.”

Lidewine Daniels

To compare the efficacy of observational and antibiotic treatment strategies, Daniels and colleagues conducted the DIABLO trial, which evaluated 528 patients with diverticulitis from 22 centers for time-to-recovery at 6 months and other adverse events. In the observational group, 13% were treated on an outpatient basis and 95% did not receive antibiotics during the study period.

At 6 months, 89.3% of patients in the observation group achieved recovery compared with 93.2% who received antibiotics (P=.183). Median time-to-recovery was similar between groups (14 days; interquartile range [IQR], 6-35 vs. 12 days; IQR, 7-30; P=.291); hazard ratio for recovery was 0.91. Readmission rates, occurence of complicated, recurrent or ongoing diverticulitis, need for sigmoid resection and other interventions, adverse events and mortality rates also were similar between groups.

“These results indicate that antibiotics can be omitted and clinical guidelines can be adjusted accordingly,” Daniels said. “This advice is in line with the containment strategy of rational use of antibiotics that WHO is promoting in trying to combat the worldwide health threat of antimicrobial resistance.”

For more information:

Daniels L. Abstract OP004. Presented at: UEG Week; Oct. 18-22, 2014; Vienna.

Disclosure: The researchers report no relevant financial disclosures.