Abstract

We aimed to investigate whether antibiotic administration is necessary for patients with uncomplicated right colonic diverticulitis. Data from patients diagnosed with uncomplicated right colonic diverticulitis, who received inpatient treatment at a single center between January 2019 and January 2021, were retrospectively examined. The patients were divided into two groups according to whether antibiotics were administered. The patients were matched between groups using propensity score matching in a 1:1 ratio using logistic regression with the nearest-neighbor method. The primary study outcome was the length of hospital stay, and the secondary outcomes were time to the introduction of sips of water and a soft diet. The study included 138 patients who received antibiotics and 59 who did not. After propensity score matching, 55 patients were assigned to each treatment group. There was no significant difference between the two groups in terms of age (p = 0.772), sex (p>0.999), body mass index (p = 0.121), prehospital symptom duration (p = 0.727), initial body temperature (p = 0.661), white blood cell count (p = 0.688), or C-reactive protein level (p = 0.337). There was also no statistically significant difference in the length of hospital stay between the no antibiotic and antibiotic groups (3.1±0.7 days vs. 3.0±1.0 days, p = 0.584). Additionally, no significant difference was observed between the no antibiotic and antibiotic groups with respect to time to sips of water (2.1±0.7 days vs. 1.8±0.9 days, p = 0.100) and time to the introduction of a soft diet (2.4±0.8 days vs. 2.1±0.9 days, p = 0.125). The findings suggest that routine antibiotics may be not required for treating patients with uncomplicated right colonic diverticulitis.

Highlights

  • The World Society of Emergency Surgery (WSES) guidelines for patients with uncomplicated left colonic diverticulitis published in 2020, state that antibiotics do not need to be prescribed for immunocompetent patients in the absence of systemic inflammation [1]

  • According to guidelines published by the Japan Gastroenterological Association in 2019, antibiotics are recommended for patients with uncomplicated right colonic diverticulitis, because there are not enough studies to justify discontinuing its use [5]

  • Among 241 consecutive patients diagnosed with right colonic diverticulitis on computed tomography (CT), 44 were excluded from the analysis owing to complicated diverticulitis (n = 15), recurrent diverticulitis (n = 22), confusion with acute appendicitis (n = 4), refusal of treatment and subsequent discharge from the hospital (n = 2), and death during hospitalization for reasons not related to diverticulitis (n = 1) (Fig 1)

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Summary

Introduction

The World Society of Emergency Surgery (WSES) guidelines for patients with uncomplicated left colonic diverticulitis published in 2020, state that antibiotics do not need to be prescribed for immunocompetent patients in the absence of systemic inflammation [1]. Routine antibiotics for right-side diverticulitis been few studies regarding antibiotic use for uncomplicated right colonic diverticulitis, which occurs at a young age and is associated with fewer complications [2,3,4]. According to guidelines published by the Japan Gastroenterological Association in 2019, antibiotics are recommended for patients with uncomplicated right colonic diverticulitis, because there are not enough studies to justify discontinuing its use [5]. Recently published results of a randomized control trial (RCT) in patients with uncomplicated right colonic diverticulitis suggest that there is no need for antibiotics in these patients [6]

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