Department of Surgery, George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Surgery Service, Veterans Affairs Medical Center, Washington, District of Columbia, USA.
J Laparoendosc Adv Surg Tech A. 2024 Nov;34(11):972-975. doi: 10.1089/lap.2024.0330. Epub 2024 Oct 23.
Acute diverticulitis represents a significant disease burden in the United States and developed world. This article examines current trends in the treatment of acute diverticulitis and concentrates on the utility of antibiotics in acute uncomplicated cases managed in the outpatient setting. The literature was reviewed for randomized controlled trials (RCTs) to discern the best practice and recommendations for antibiotics for diverticulitis. The time period included relevant RCTs after 2000. Four recent RCTs examine the use of antibiotics in acute uncomplicated diverticulitis. The AVOD study was an RCT that managed inpatients with either antibiotics or IV fluids alone and demonstrated non-inferiority of non-antibiotic management with respect to recovery, complication rates, or recurrence. The DIABLO trial randomized first episodes of acute uncomplicated diverticulitis admitted to the hospital with antibiotics or supportive care and found no difference in morbidity or mortality between the two groups and longer hospital stay for patients treated with antibiotics. The DINAMO study examined outpatients managed with antibiotics by mouth or without and found no difference in morbidity in 90 day follow-up. The STAND study was the only of these four to use a placebo and found no difference between hospital stay or other adverse events at 30 days. In response to this, the ASCRS, AAFP and other societies now recommend against the routine use of antibiotics in acute uncomplicated diverticulitis. Several quality studies found similar outcomes in cases of acute uncomplicated diverticulitis treated with or without antibiotics. Based on these findings, societal guidelines do not recommend routine antibiotics for acute diverticulitis.
急性憩室炎在美国和发达国家是一种重大的疾病负担。本文研究了急性憩室炎治疗的当前趋势，并集中讨论了在门诊环境下管理的急性单纯性病例中使用抗生素的效用。本文回顾了随机对照试验（RCT）的文献，以确定急性憩室炎抗生素治疗的最佳实践和建议。时间范围包括 2000 年后的相关 RCT。四项最近的 RCT 研究了抗生素在急性单纯性憩室炎中的应用。AVOD 研究是一项 RCT，管理住院患者仅用抗生素或静脉补液，结果表明非抗生素管理在恢复、并发症发生率或复发方面不劣于抗生素管理。DIABLO 试验随机分配急性单纯性憩室炎首次发作的住院患者使用抗生素或支持性治疗，发现两组之间在发病率或死亡率方面没有差异，且抗生素治疗患者的住院时间更长。DINAMO 研究研究了门诊患者口服抗生素或不使用抗生素的情况，发现 90 天随访时发病率无差异。STAND 研究是这四项研究中唯一使用安慰剂的研究，发现 30 天时住院时间或其他不良事件无差异。对此，ASCRS、AAFP 和其他学会现在建议不要在急性单纯性憩室炎常规使用抗生素。几项质量研究发现，在急性单纯性憩室炎治疗中使用或不使用抗生素的病例中，结果相似。基于这些发现，社会指南不建议常规使用抗生素治疗急性憩室炎。
