Maheshwari Gaurav, Khalid Sadaf, Ansari Abil, Elmoraly Ahmed, Javaid Ayesha, Mumtaz Muhammad Rehan, Ali Zulfiqar
General and Colorectal Surgery, Medway Maritime NHS Foundation Trust, Kent, GBR.
Medicine, Medway Maritime Hospital NHS Trust, Kent, GBR.
Cureus. 2025 Jun 29;17(6):e86951. doi: 10.7759/cureus.86951. eCollection 2025 Jun.
Acute uncomplicated diverticulitis (AUD) is often treated with antibiotics, though recent evidence questions their necessity in clinically stable patients. Concerns over antibiotic resistance have prompted consideration of conservative, non-antibiotic management, but clinical equivalence remains debated. This study aimed to compare antibiotic versus non-antibiotic management for CT (computed tomography)-confirmed AUD in adults, focusing on outcomes like mortality, complications, recurrence, surgery, and length of hospital stay (LOS). A systematic search (2016-2025) was carried out across five databases, identifying randomized controlled trials (RCTs) comparing antibiotic to conservative treatment in patients with Hinchey 1a/1b or Modified Neff grade 0 diverticulitis. Two reviewers independently extracted data and assessed bias using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes were analyzed using a DerSimonian-Laird random-effects model. Seven RCTs (n = 8,035) met inclusion criteria. No significant differences were found in mortality (odds ratio (OR) 1.06; 95% CI: 0.71-1.58), complications (OR 0.67; 95% CI: 0.27-1.67), emergency surgery (OR 0.60; 95% CI: 0.23-1.54), or recurrence (OR 0.96; 95% CI: 0.65-1.44). LOS was marginally shorter in the conservative group. Heterogeneity for mortality and LOS was moderate (I² = 43.2%). Most studies defined clinical stability based on the absence of systemic signs and CT-confirmed localized inflammation; some variations in diagnostic criteria were noted. Conservative treatment without antibiotics in select AUD patients yields comparable outcomes to antibiotic use. These findings support guideline recommendations favoring selective antibiotic use, though heterogeneity in population definitions and short follow-up in some studies should be noted.
急性单纯性憩室炎（AUD）通常采用抗生素治疗，不过最近的证据对临床稳定患者使用抗生素的必要性提出了质疑。对抗生素耐药性的担忧促使人们考虑采用保守的非抗生素治疗方法，但临床等效性仍存在争议。本研究旨在比较成人CT（计算机断层扫描）确诊的AUD患者使用抗生素与非抗生素治疗的效果，重点关注死亡率、并发症、复发率、手术情况及住院时间（LOS）等结果。对五个数据库进行了系统检索（2016 - 2025年），确定了比较抗生素治疗与保守治疗的随机对照试验（RCT），这些试验针对的是欣奇1a/1b级或改良内夫0级憩室炎患者。两名审阅者独立提取数据，并根据系统评价和Meta分析的首选报告项目（PRISMA）指南评估偏倚。主要结果采用DerSimonian-Laird随机效应模型进行分析。七项RCT（n = 8,035）符合纳入标准。在死亡率（优势比（OR）1.06；95%置信区间：0.71 - 1.58）、并发症（OR 0.67；95%置信区间：0.27 - 1.67）、急诊手术（OR 0.60；95%置信区间：0.23 - 1.54）或复发率（OR 0.96；95%置信区间：0.65 - 1.44）方面未发现显著差异。保守治疗组的住院时间略短。死亡率和住院时间的异质性为中度（I² = 43.2%）。大多数研究根据无全身症状和CT证实的局部炎症来定义临床稳定性；注意到诊断标准存在一些差异。在部分AUD患者中，不使用抗生素的保守治疗与使用抗生素的效果相当。这些发现支持了倾向于选择性使用抗生素的指南建议，不过应注意人群定义的异质性以及一些研究随访时间较短的问题。
