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Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure

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Abstract

Background

Diverticulitis is a common complication of diverticular disease of the colon. While complicated diverticulitis often warrants intervention, acute uncomplicated diverticulitis (AUD) is usually managed conservatively. The aim of the present review was to evaluate the efficacy and safety of conservative treatment of AUD without antibiotics compared to standard antibiotic treatment.

Methods

A systematic literature review in compliance with PRISMA guidelines was conducted. Electronic databases including PubMed/Medline, Scopus, Embase and Cochrane central register of controlled trials were searched. Studies that assessed efficacy and safety of treatment of AUD without antibiotics were included. Outcome parameters were rates of treatment failure, recurrence of diverticulitis, complications and mortality, readmission to hospital, and need for surgery.

Results

Nine studies including 2565 patients were included to the review. Of these patients, 65.1% were treated conservatively without antibiotics. Treatment failure was observed in 5.1% of patients not-given-antibiotic treatment versus 3.4% of those given antibiotic treatment. Recurrent diverticulitis occurred in 9.3% of patients in the non-antibiotic group versus 12.1% of patients in the antibiotic group. On meta-analysis of the studies, there were no significant differences between non-antibiotic and antibiotic treatment groups regarding rates of treatment failure (OR = 1.5, p = 0.06), recurrence of diverticulitis (OR = 0.81, p = 0.2), complications (OR = 0.56, p = 0.25), readmission rates (OR = 0.97, p = 0.91), need for surgery (OR = 0.59, p = 0.28), and mortality (OR = 0.64, p = 0.47). The only variable that was significantly associated with treatment failure in the non-antibiotic treatment group was associated comorbidities (standard error (SE) = − 0.07, 95% CI − 0.117 − 0.032; p < 0.001).

Conclusions

Treatment of AUD without antibiotics is feasible, safe, and effective. Adding broad-spectrum antibiotics to the treatment regimen did not serve to decrease treatment failure, recurrence, complications, hospital readmissions, and need for surgery significantly compared to non-antibiotic treatment.

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Acknowledgements

The authors would like to express their thanks and gratitude to Professor Basem Eldeek, PhD for his sincere help in conducting and reviewing the statistical analyses used in the present systematic review and meta-analysis.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura City, Egypt

    S. H. Emile, H. Elfeki, A. Sakr & M. Shalaby

  2. Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

    H. Elfeki

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  1. S. H. Emile
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  2. H. Elfeki
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  3. A. Sakr
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  4. M. Shalaby
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Contributions

SHE designed the review. SHE, HE, MS, and AS participated in data collection and analysis, writing and drafting of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to S. H. Emile.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Emile, S.H., Elfeki, H., Sakr, A. et al. Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure. Tech Coloproctol 22, 499–509 (2018). https://doi.org/10.1007/s10151-018-1817-y

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