Colorectal Unit, Department of Surgery, and Centre for Clinical Research Uppsala University, Västmanlands Hospital, Västerås, Sweden.
Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688. Epub 2012 Jan 30.
The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. The aim was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis, with the endpoint of recovery without complications after 12 months of follow-up.
This multicentre randomized trial involving ten surgical departments in Sweden and one in Iceland recruited 623 patients with computed tomography-verified acute uncomplicated left-sided diverticulitis. Patients were randomized to treatment with (314 patients) or without (309 patients) antibiotics.
Age, sex, body mass index, co-morbidities, body temperature, white blood cell count and C-reactive protein level on admission were similar in the two groups. Complications such as perforation or abscess formation were found in six patients (1·9 per cent) who received no antibiotics and in three (1·0 per cent) who were treated with antibiotics (P = 0·302). The median hospital stay was 3 days in both groups. Recurrent diverticulitis necessitating readmission to hospital at the 1-year follow-up was similar in the two groups (16 per cent, P = 0·881).
Antibiotic treatment for acute uncomplicated diverticulitis neither accelerates recovery nor prevents complications or recurrence. It should be reserved for the treatment of complicated diverticulitis.
目前急性单纯性憩室炎的标准治疗方法是抗生素治疗，尽管没有支持这种治疗方法的对照研究。本研究旨在探讨急性单纯性憩室炎是否需要抗生素治疗，以 12 个月随访时无并发症恢复为终点。
这项多中心随机试验纳入了瑞典的 10 个外科科室和冰岛的 1 个科室共 623 例经计算机断层扫描证实的急性单纯性左侧憩室炎患者。患者随机接受抗生素治疗（314 例）或不接受抗生素治疗（309 例）。
两组患者的年龄、性别、体重指数、合并症、体温、白细胞计数和 C 反应蛋白水平在入院时相似。未接受抗生素治疗的 6 例（1.9%）和接受抗生素治疗的 3 例（1.0%）患者出现穿孔或脓肿形成等并发症（P=0.302）。两组患者的中位住院时间均为 3 天。两组在 1 年随访时需要再次住院治疗的复发性憩室炎的发生率相似（16%，P=0.881）。
急性单纯性憩室炎抗生素治疗既不能加速康复，也不能预防并发症或复发。抗生素应保留用于治疗复杂性憩室炎。
