PMID- 30650309
OWN - NLM
STAT- MEDLINE
DCOM- 20190513
LR  - 20190513
IS  - 1502-7708 (Electronic)
IS  - 0036-5521 (Linking)
VI  - 54
IP  - 1
DP  - 2019 Jan
TI  - Acute uncomplicated diverticulitis managed without antibiotics - difficult to 
      introduce a new treatment protocol but few complications.
PG  - 64-68
LID - 10.1080/00365521.2018.1552987 [doi]
AB  - OBJECTIVE: Routine antibiotic treatment of acute uncomplicated diverticulitis 
      (AUD) has been shown ineffective. In this study, the adherence to a new treatment 
      protocol for uncomplicated diverticulitis was evaluated and the incidence of 
      complications in patients treated with and without antibiotics was investigated. 
      MATERIALS AND METHODS: A retrospective study of in-patients diagnosed with AUD at 
      Helsingborg Hospital, Sweden between 01 January 2013 and 06 January 2015 was 
      performed. Antibiotics were routinely administrated until 01 May 2014. 
      Thereafter, a new antibiotic-free treatment protocol for uncomplicated 
      diverticulitis was introduced. All the patients were followed regarding 
      complications for minimum one year. RESULTS: A total of 50 patients were studied 
      after the new protocol implementation and, 60% (n = 31) of the patients were 
      treated without antibiotics. Specialists initiated antibiotic therapy 
      significantly more often than registrars (p=.03). More patients in the antibiotic 
      group had comorbidities (p=.03), apart from that, no significant differences in 
      baseline characteristics were noted between treatment groups. Patients treated 
      with antibiotics after introduction of the new protocol had significantly higher 
      C-reactive protein than patients managed without antibiotics (median 117 mg/L vs. 
      70, p=.005). The hospital stay was shorter in the non-antibiotic group (three 
      days vs. two days; p=.008). No significant differences in complications were 
      observed. CONCLUSIONS: Protocol compliance was lower than expected, indicating 
      that implementation of new treatment regimens is challenging. This study confirms 
      that complications are rare in AUD treated without antibiotics. However, the 
      selection of the sickest patients to the treatment with antibiotics limits the 
      interpretation of the results.
FAU - Azhar, Najia
AU  - Azhar N
AUID- ORCID: 0000-0001-6709-4441
AD  - a Colorectal Unit, Department of Surgery , Skane University Hospital Malmo , 
      Malmo, Sweden.
FAU - Kulstad, Hanna
AU  - Kulstad H
AD  - b Department of Surgery , Helsingborg Hospital , Helsingborg , Sweden.
FAU - Palsson, Birger
AU  - Palsson B
AD  - b Department of Surgery , Helsingborg Hospital , Helsingborg , Sweden.
FAU - Kurt Schultz, Johannes
AU  - Kurt Schultz J
AD  - c Department of Digestive Surgery , Akershus University Hospital , Lorenskog , 
      Norway.
FAU - Lydrup, Marie-Louise
AU  - Lydrup ML
AD  - a Colorectal Unit, Department of Surgery , Skane University Hospital Malmo , 
      Malmo, Sweden.
FAU - Buchwald, Pamela
AU  - Buchwald P
AD  - a Colorectal Unit, Department of Surgery , Skane University Hospital Malmo , 
      Malmo, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20190116
PL  - England
TA  - Scand J Gastroenterol
JT  - Scandinavian journal of gastroenterology
JID - 0060105
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Conservative Treatment/*methods
MH  - Diverticulitis, Colonic/*therapy
MH  - Female
MH  - Humans
MH  - Length of Stay/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Sweden
MH  - Treatment Outcome
OTO - NOTNLM
OT  - GI-infections
OT  - colonic disorders
EDAT- 2019/01/17 06:00
MHDA- 2019/05/14 06:00
CRDT- 2019/01/17 06:00
PHST- 2019/01/17 06:00 [pubmed]
PHST- 2019/05/14 06:00 [medline]
PHST- 2019/01/17 06:00 [entrez]
AID - 10.1080/00365521.2018.1552987 [doi]
PST - ppublish
SO  - Scand J Gastroenterol. 2019 Jan;54(1):64-68. doi: 10.1080/00365521.2018.1552987. 
      Epub 2019 Jan 16.