title: Systematic review: outpatient management of acute uncomplicated diverticulitis.
abstract: OBJECTIVE
  Acute uncomplicated diverticulitis is traditionally managed by inpatient admission for bowel rest, intravenous fluids and intravenous antibiotics. In recent years, an increasing number of publications have sought to determine whether care might instead be conducted in the community, with earlier enteral feeding and oral antibiotics. This systematic review evaluates the safety and efficacy of such an ambulatory approach.
  
  
  METHODS
  Medline, Embase and Cochrane Library databases were searched. All peer-reviewed studies that investigated the role of ambulatory treatment protocols for acute uncomplicated diverticulitis, either directly or indirectly, were eligible for inclusion.
  
  
  RESULTS
  Nine studies were identified as being suitable for inclusion, including one randomised controlled trial, seven prospective cohort studies and one retrospective cohort study. All, except one, employed imaging as part of their diagnostic criteria. There was inconsistency between studies with regards to whether patients with significant co-morbidities were eligible for ambulatory care and whether bowel rest therapy was employed. Neither of these variables influenced outcome. Across all studies, 403 out of a total of 415 (97 %) participants were successfully treated for an episode of acute uncomplicated diverticulitis using an outpatient-type approach. Cost savings ranged from 35.0 to 83.0 %.
  
  
  CONCLUSIONS
  Current evidence suggests that a more progressive, ambulatory-based approach to the majority of cases of acute uncomplicated diverticulitis is justified. Based on this evidence, the authors present a possible outpatient-based treatment algorithm. An appropriately powered randomised controlled trial is now required to determine its safety and efficacy compared to traditional inpatient management.
authors.affiliation: Barts and The London School of Medicine and Dentistry, London, UK, welshjohndj@hotmail.com.
authors.forename: J D
authors.initials: JD
authors.lastname: Jackson
authors.forename: T
authors.initials: T
authors.lastname: Hammond
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004238:Diverticulitis / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005440:Fluid Therapy; D006801:Humans; D007262:Infusions, Intravenous; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents