title: Mild colonic diverticulitis can be treated without antibiotics. A case-control study.
abstract: OBJECTIVE
  Conservative treatment of mild colonic diverticulitis usually consists of observation, restriction of oral intake, intravenous fluids and antibiotics. The beneficiary effect of antibiotics remains unclear. The aim of this study is to evaluate the need for antibiotics in mild colonic diverticulitis.
  
  
  METHODS
  A retrospective case-control study was performed in 272 patients with mild colonic diverticulitis admitted to two hospitals with distinctly different treatment regimes concerning antibiotic use.
  
  
  RESULTS
  A total of 191 patients were treated without antibiotics and 81 with antibiotics. Groups were comparable at baseline with respect to age, sex, comorbidity, and use of nonsteroid anti-inflammatory drugs, steroids and aspirin. All patients had imaging-confirmed diverticulitis. C reactive protein and white blood count levels did not differ significantly. In the antibiotics group there were significantly more patients with a temperature of 38.5°C or higher on admission. (8 vs 19%; P=0.014). Treatment failure did not differ between groups (4 vs 6%; P=0.350). The risk of recurrence was higher in the antibiotics group on logistic regression analysis but did not reach statistical significance (odds ratio, 2.04; confidence interval, 0.88-4.75; P=0.880). The only factor that increased the risk of recurrence was nonsteroid anti-inflammatory drug use (odds ratio, 7.25; confidence interval, 1.22-46.88; P=0.037).
  
  
  CONCLUSIONS
  Antibiotics can be omitted in selected patients with mild colonic diverticulitis and should be given on indication only.
authors.affiliation: Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands. ndekorte@yahoo.com
authors.forename: N
authors.initials: N
authors.lastname: de Korte
authors.forename: J Ph
authors.initials: JP
authors.lastname: Kuyvenhoven
authors.forename: D L
authors.initials: DL
authors.lastname: van der Peet
authors.forename: R J
authors.initials: RJ
authors.lastname: Felt-Bersma
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: H B A C
authors.initials: HB
authors.lastname: Stockmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000628:therapy*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents