Background & Aims

Antibiotic treatment is the standard care for patients with uncomplicated acute diverticulitis. However, this practice is based on low-level evidence and has been challenged by findings from 2 randomized trials, which did not include a placebo group. We investigated the non-inferiority of placebo vs antibiotic treatment for the management of uncomplicated acute diverticulitis.

Methods

In the selective treatment with antibiotics for non-complicated diverticulitis study, 180 patients hospitalized for uncomplicated acute diverticulitis (determined by computed tomography, Hinchey 1a grade) from New Zealand and Australia were randomly assigned to groups given antibiotics (n = 85) or placebo (n = 95) for 7 days. We collected demographic, clinical, and laboratory data and answers to questionnaires completed every 12 hrs for the first 48 hrs and then daily until hospital discharge. The primary endpoint was length of hospital stay; secondary endpoints included occurrence of adverse events, readmission to the hospital, procedural intervention, change in serum markers of inflammation, and patient-reported pain scores at 12 and 24 hrs.

Results

There was no significant difference in median time of hospital stay between the antibiotic group (40.0 hrs; 95% CI, 24.4–57.6 hrs) and the placebo group (45.8 hrs; 95% CI, 26.5–60.2 hrs) (P = .2). There were no significant differences between groups in adverse events (12% for both groups; P = 1.0), readmission to the hospital within 1 week (1% for the placebo group vs 6% for the antibiotic group; P = .1), and readmission to the hospital within 30 days (11% for the placebo group vs 6% for the antibiotic group; P = .3).

Conclusions

Foregoing antibiotic treatment did not prolong length of hospital admission. This result provides strong evidence for omission of antibiotics for selected patients with uncomplicated acute diverticulitis. ACTRN: 12615000249550.

中文翻译：

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在一项务实的双盲随机试验中，抗生素不会减少单纯性憩室炎的住院时间

背景与目标

抗生素治疗是无并发症的急性憩室炎患者的标准护理。然而，这种做法基于低水平的证据，并受到两项随机试验结果的挑战，其中不包括安慰剂组。我们研究了安慰剂与抗生素治疗在治疗无并发症的急性憩室炎方面的非劣效性。

方法

在抗生素选择性治疗非复杂性憩室炎研究中，来自新西兰和澳大利亚的 180 名因非复杂性急性憩室炎（通过计算机断层扫描确定，Hinchey 1a 级）住院的患者被随机分配到接受抗生素组（n = 85）或安慰剂组（n = 85）。 n = 95) 7 天。我们收集人口统计、临床和实验室数据以及前 48 小时内每 12 小时完成一次的调查问卷答案，然后每天收集一次，直至出院。主要终点是住院时间；次要终点包括不良事件的发生、再次入院、程序干预、血清炎症标记物的变化以及患者报告的 12 小时和 24 小时疼痛评分。

结果

抗生素组（40.0 小时；95% CI，24.4-57.6 小时）和安慰剂组（45.8 小时；95% CI，26.5-60.2 小时）之间的中位住院时间没有显着差异（P = .2） ）。不良事件（两组均为 12%；P = 1.0）、1 周内再次入院（安慰剂组为 1% vs 抗生素组为 6%；P = .1）方面组间没有显着差异。 30 天内再次入院（安慰剂组为 11%，抗生素组为 6%；P = .3）。

结论

上述抗生素治疗并没有延长住院时间。这一结果为选定的无并发症急性憩室炎患者省略抗生素提供了强有力的证据。行动电话：12615000249550。