Rezapour Mona, Stollman Neil
Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA.
Alta Bates Summit Medical Center, East Bay Center for Digestive Health, Oakland, California, USA.
Inflamm Intest Dis. 2018 Dec;3(2):75-79. doi: 10.1159/000489631. Epub 2018 Jul 20.
Acute uncomplicated diverticulitis (AUD) is generally felt to be caused by obstruction and inflammation of a colonic diverticulum and occurs in about 4-5% of patients with diverticulosis. The cornerstone of AUD treatment has conventionally been antibiotic therapy, but with a paradigm shift in the underlying pathogenesis of the disease from bacterial infection to more of an inflammatory process, as well as concerns about antibiotic overuse, this dogma has recently been questioned. We will review emerging data that supports more selective antibiotic use in this population, as well as newer guidelines that advocate this position as well. While there are no discrete algorithms to guide us, we will attempt to suggest clinical scenarios where antibiotics may reasonably be withheld.
急性非复杂性憩室炎（AUD）通常被认为是由结肠憩室梗阻和炎症引起的，约4%-5%的憩室病患者会发生此病。传统上，AUD治疗的基石是抗生素治疗，但随着该疾病潜在发病机制从细菌感染向更多的炎症过程转变，以及对抗生素过度使用的担忧，这一教条最近受到了质疑。我们将回顾支持在该人群中更有选择性地使用抗生素的新数据，以及也倡导这一立场的新指南。虽然没有明确的算法来指导我们，但我们将尝试提出一些可以合理停用抗生素的临床情况。
