title: Antibiotics for uncomplicated diverticulitis.
abstract: BACKGROUND
  Diverticulitis is an inflammatory complication to the very common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics with reference to the microbiology, extrapolation from trials on complicated intra-abdominal infections and clinical experience.
  
  
  OBJECTIVE
  To assess the effects of antibiotic interventions for uncomplicated diverticulitis on relevant outcome.
  
  
  METHODS
  Studies were identified by computerised searches of the The Cochrane Library (CENTRAL), MEDLINE and EMBASE. Ongoing trials were identified and reference lists of identified trials and relevant review articles were screened for additional studies.
  
  
  METHODS
  RCTs including all types of patients with a radiological confirmed diagnosis of left-sided uncomplicated diverticulitis. Interventions of antibiotics compared to any other antibiotic treatment (different regime, route of administration, dosage or duration of treatment), placebo or no antibiotics. Outcome measures were complications, emergency surgery, recurrence, late complications and duration of hospital stay and recovery of signs of infection.
  
  
  METHODS
  Two authors performed the searches, identification of RCTs, trial assessment and data extraction. Disagreements were resolved by discussion or involvement of a third part. Authors of trials were contacted to obtain additional data if needed or were contacted for preliminary results of ongoing trials. Effect estimates were extracted as relative risks (RR).
  
  
  RESULTS
  Three RCTs were identified. A qualitative approach with no meta analysis was performed because of variety in interventions between included studies. Interventions compared were antibiotics to no antibiotics, single to double compound antibiotic therapy and short to long IV administration. None of the studies found significant difference between the tested interventions. Risk of bias varied from low to high. The newest RCT overall had the best quality and statistical power.
  
  
  CONCLUSIONS
  The newest evidence from one RCT says there is no significant difference between antibiotics versus no antibiotics in the treatment of uncomplicated diverticulitis. Previous RCTs have only suggested a non-inferiority between different antibiotic regimes and treatment lengths. This new evidence needs confirmation from more RCTs before it can be implicated safely in clinical guidelines. Ongoing RCTs will be published in the years to come and more are needed. The role of antibiotics in the treatment of complicated diverticulitis has not been investigated yet.
authors.affiliation: Department of Surgical Gastroenterology K, Bispebjerg Hospital, Copenhagen NV, Denmark. dmshaban@gmail.com
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Shabanzadeh
authors.forename: Peer
authors.initials: P
authors.lastname: Wille-Jørgensen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004238:Diverticulitis / Q000188:drug therapy*; D006801:Humans; D007420:Intestine, Large; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents