Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands.
Colorectal Dis. 2012 Mar;14(3):325-30. doi: 10.1111/j.1463-1318.2011.02609.x.
Conservative treatment of mild colonic diverticulitis usually consists of observation, restriction of oral intake, intravenous fluids and antibiotics. The beneficiary effect of antibiotics remains unclear. The aim of this study is to evaluate the need for antibiotics in mild colonic diverticulitis.
A retrospective case-control study was performed in 272 patients with mild colonic diverticulitis admitted to two hospitals with distinctly different treatment regimes concerning antibiotic use.
A total of 191 patients were treated without antibiotics and 81 with antibiotics. Groups were comparable at baseline with respect to age, sex, comorbidity, and use of nonsteroid anti-inflammatory drugs, steroids and aspirin. All patients had imaging-confirmed diverticulitis. C reactive protein and white blood count levels did not differ significantly. In the antibiotics group there were significantly more patients with a temperature of 38.5°C or higher on admission. (8 vs 19%; P=0.014). Treatment failure did not differ between groups (4 vs 6%; P=0.350). The risk of recurrence was higher in the antibiotics group on logistic regression analysis but did not reach statistical significance (odds ratio, 2.04; confidence interval, 0.88-4.75; P=0.880). The only factor that increased the risk of recurrence was nonsteroid anti-inflammatory drug use (odds ratio, 7.25; confidence interval, 1.22-46.88; P=0.037).
Antibiotics can be omitted in selected patients with mild colonic diverticulitis and should be given on indication only.
轻度结肠憩室炎的保守治疗通常包括观察、限制口服摄入、静脉补液和使用抗生素。抗生素的有益效果仍不清楚。本研究旨在评估轻度结肠憩室炎中抗生素的使用是否有必要。
对两家医院的 272 例轻度结肠憩室炎患者进行了回顾性病例对照研究，这两家医院在抗生素使用方面的治疗方案明显不同。
共有 191 例患者未接受抗生素治疗，81 例患者接受了抗生素治疗。两组患者在年龄、性别、合并症以及非甾体抗炎药、类固醇和阿司匹林的使用方面基线相似。所有患者均经影像学证实患有憩室炎。C 反应蛋白和白细胞计数水平无显著差异。在抗生素组中，入院时体温为 38.5°C 或更高的患者明显更多（8% vs 19%；P=0.014）。两组之间的治疗失败率无显著差异（4% vs 6%；P=0.350）。在逻辑回归分析中，抗生素组的复发风险较高，但未达到统计学意义（优势比，2.04；置信区间，0.88-4.75；P=0.880）。唯一增加复发风险的因素是非甾体抗炎药的使用（优势比，7.25；置信区间，1.22-46.88；P=0.037）。
在选择的轻度结肠憩室炎患者中可以省略抗生素，并且仅在有指征时使用。
