Tandon Ashutosh, Fretwell Victoria L, Nunes Quentin M, Rooney Paul S
Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL.
Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK.
Colorectal Dis. 2018 Jan 11. doi: 10.1111/codi.14013.
Acute uncomplicated diverticulitis (AUD) is common and antibiotics are the cornerstone of traditional conservative management. This approach lacks clear evidence base and studies have recently suggested that avoidance of antibiotics is a safe and efficacious way to manage AUD. The aim of this systematic review is to determine the safety and efficacy of treating AUD without antibiotics.
A systematic search of Embase, Cochrane library, MEDLINE, Science Citation Index Expanded, and ClinicalTrials. gov was performed. Studies comparing antibiotics versus no antibiotics in the treatment of AUD were included. Meta-analysis was performed using the random effects model with the primary outcome measure being diverticulitis-associated complications. Secondary outcomes were readmission rate, diverticulitis recurrence, mean hospital stay, requirement for surgery and requirement for percutaneous drainage.
Eight studies were included involving 2469 patients; 1626 in the non-antibiotic group (NAb) and 843 in the antibiotic group (Ab). There was a higher complication rate in the Ab group however this was not significant (1.9% versus 2.6%) with a combined risk ratio (RR) of 0.63 (95% CI, 0.25 to 1.57, p=0.32). There was a shorter mean length of hospital stay in the Nab group (standard mean difference of -1.18 (95% CI, -2.34 to -0.03 p= 0.04). There was no significant difference in readmission, recurrence and surgical intervention rate or requirement for percutaneous drainage.
Treatment of AUD without antibiotics may be feasible with outcomes that are comparable to antibiotic treatment and with potential benefits for patients and the NHS. Large scale randomised multicentre studies are needed. This article is protected by copyright. All rights reserved.
急性单纯性憩室炎（AUD）很常见，抗生素是传统保守治疗的基石。这种方法缺乏明确的证据基础，最近的研究表明，避免使用抗生素是治疗AUD的一种安全有效的方法。本系统评价的目的是确定不使用抗生素治疗AUD的安全性和有效性。
对Embase、Cochrane图书馆、MEDLINE、科学引文索引扩展版和ClinicalTrials.gov进行系统检索。纳入比较抗生素与不使用抗生素治疗AUD的研究。采用随机效应模型进行荟萃分析，主要结局指标为憩室炎相关并发症。次要结局指标为再入院率、憩室炎复发率、平均住院时间、手术需求和经皮引流需求。
纳入八项研究，共2469例患者；非抗生素组（NAb）1626例，抗生素组（Ab）843例。Ab组并发症发生率较高，但差异无统计学意义（1.9%对2.6%），合并风险比（RR）为0.63（95%CI，0.25至1.57，p = 0.32）。Nab组平均住院时间较短（标准均差为-1.18，95%CI，-2.34至-0.03，p = 0.04）。再入院率、复发率、手术干预率或经皮引流需求方面差异无统计学意义。
不使用抗生素治疗AUD可能是可行的，其结果与抗生素治疗相当，对患者和英国国家医疗服务体系可能有潜在益处。需要开展大规模随机多中心研究。本文受版权保护。保留所有权利。
