Huston Jared M, Zuckerbraun Brian S, Moore Laura J, Sanders James M, Duane Therese M
1 Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell , Manhasset, New York.
2 Department of Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
Surg Infect (Larchmt). 2018 Oct;19(7):648-654. doi: 10.1089/sur.2018.115. Epub 2018 Sep 11.
Acute diverticulitis occurs in 25% of individuals with diverticular disease and is associated with significant morbidity and mortality rates. Disease severity is classified as uncomplicated or complicated, with the latter including perforation, fistula, obstruction, or distant abscess. Uncomplicated diverticulitis often improves without surgery or invasive therapies. Administration of antibiotics is a standard of care for treatment of acute uncomplicated diverticulitis. However, recent data suggest antibiotics do not influence outcomes significantly. To address these conflicting approaches, the Surgical Infection Society hosted an Update Symposium at its 37 Annual Meeting examining the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Here, we provide a synopsis of the symposium's findings and a brief review of recent prospective and randomized clinical trials on the topic.
A search of Embase, MEDLINE, and the Cochrane Library was performed for prospective series and randomized clinical trials published between January 1, 2010, and January 1, 2018, comparing outcomes of antibiotic versus no antibiotic therapy for acute uncomplicated diverticulitis.
We identified two single-center prospective series and two randomized clinical trials comparing outcomes for patients with acute uncomplicated diverticulitis treated with antibiotics versus no antibiotics.
Current evidence does not support administration of antibiotics to improve outcomes in carefully selected healthy patients with acute uncomplicated left-sided diverticulitis. Further studies should help identify specific subpopulations of patients who would derive benefit from antibiotic therapy and help define appropriate antibiotic regimens and treatment durations that minimize cost, adverse effects, and risk of anti-microbial resistance.
急性憩室炎发生于25%的憩室病患者中，且与显著的发病率和死亡率相关。疾病严重程度分为非复杂性或复杂性，后者包括穿孔、瘘管、梗阻或远处脓肿。非复杂性憩室炎通常无需手术或侵入性治疗即可改善。使用抗生素是治疗急性非复杂性憩室炎的标准治疗方法。然而，最近的数据表明抗生素对治疗结果并无显著影响。为解决这些相互矛盾的治疗方法，外科感染协会在其第37届年会上举办了一次更新研讨会，探讨抗生素在急性非复杂性憩室炎治疗中的作用。在此，我们提供研讨会结果的概要以及对该主题近期前瞻性和随机临床试验的简要综述。
检索Embase、MEDLINE和Cochrane图书馆，查找2010年1月1日至2018年1月1日期间发表的前瞻性系列研究和随机临床试验，比较抗生素治疗与不使用抗生素治疗急性非复杂性憩室炎的结果。
我们确定了两项单中心前瞻性系列研究和两项随机临床试验，比较了使用抗生素与不使用抗生素治疗急性非复杂性憩室炎患者的结果。
目前的证据不支持对精心挑选的患有急性非复杂性左侧憩室炎的健康患者使用抗生素来改善治疗结果。进一步的研究应有助于确定能从抗生素治疗中获益的特定患者亚群，并有助于确定合适的抗生素方案和治疗持续时间，以尽量降低成本、不良反应和抗菌耐药风险。
