Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis.
BACKGROUND
In most cases of diverticulitis, inflammation is mild, and the only treatment required is a clear liquid diet and antibiotics. Until recently, patients were given this treatment as inpatients with the consequent expenditure of resources. The aim of this study was to assess the safety and efficacy of an outpatient treatment protocol with oral antibiotics in selected patients with uncomplicated acute diverticulitis in comparison with inpatient intravenous treatment.


METHODS
We conducted a prospective non-randomized study between January 2007 and December 2009. We included all patients diagnosed with uncomplicated acute diverticulitis, at the Emergency Department of the University General Hospital of Elche. We compared the efficacy, safety and costs of hospital treatment with intravenous antibiotics and outpatient treatment with oral antibiotics. Seventy-six patients were included in the study. Forty-four of them underwent intravenous treatment with Metronidazole 500 mg/8 h + Ciprofloxacin 400 mg/12 h (hospital treatment group) and 32 took oral antibiotics Metronidazole 500 mg/8 h and Ciprofloxacin 500 mg/12 h (outpatient group).


RESULTS
Outpatient treatment is viable in almost 95 % of those patients suffering from uncomplicated acute diverticulitis. Treatment was effective in resolving inflammation, and there were no complications in the majority of cases (94 %). Only 2 patients (6 %) required admission after outpatient treatment. The results further reflect complications and relapse rates similar to those of patients admitted to hospital and treated with intravenous antibiotics. There are no significant statistical differences (p = 0.86) between inpatients and outpatients. It is possible to save approximately 1,600 € per patient with outpatient treatment (p < 0.05).


CONCLUSIONS
Outpatient treatment has demonstrated a safety and efficiency similar to inpatient treatment, producing an important reduction in expenses and medical resources.
Department of Surgery, University General Hospital of Elche, Alicante, Spain. pedromoyaforcen@gmail.com
P
P
Moya
A
A
Arroyo
J
J
Pérez-Legaz
P
P
Serrano
F
F
Candela
L
L
Soriano-Irigaray
R
R
Calpena
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D003113:Colonoscopy; D003131:Combined Modality Therapy; D004238:Diverticulitis / Q000178:diet therapy* / Q000188:drug therapy*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D008795:Metronidazole; D000082:Acetaminophen; D002939:Ciprofloxacin