title: Selective non-antibiotic treatment in sigmoid diverticulitis: is it time to change the traditional approach?
abstract: BACKGROUND
  A growing body of knowledge is calling into question the use of antibiotics in acute diverticulitis (AD). Moreover, recent studies provide evidence regarding the security of treating patients with AD as outpatients. The aim of this study was to evaluate a restrictive antibiotic outpatient protocol for the treatment of mild-to-moderate episodes of AD.
  
  
  METHODS
  All patients with symptoms of AD presenting to our emergency department were assigned a modified Neff stage. Patients with mild AD received outpatient treatment without antibiotics. Patients with mild AD and comorbidities were admitted to receive the same treatment. Patients with moderate AD were admitted for 48 h and were then managed as outpatients until they had completed 10 days of antibiotic treatment.
  
  
  RESULTS
  Between April 2013 and November 2014, we attended 110 patients with a diagnosis of AD, 77 of whom we included in the study: 45 patients with mild AD and 32 with moderate AD. Of the patients with mild AD, 88.8 % successfully completed the non-antibiotic, non-admission treatment regime and 95.5 % benefited from a non-antibiotic regime, whether as outpatients or inpatients. A total of 88 % of patients with mild AD and 87.5 % of patients with moderate AD who met the inclusion criteria completed treatment as outpatients without incident. No major complications (abscess, emergency surgery) or deaths were recorded.
  
  
  CONCLUSIONS
  Outpatient treatment without antibiotics for patients with mild AD is safe and effective. Patients with moderate AD can be safely treated with antibiotics in a mixed regime as inpatients and outpatients.
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain. oestrada@csdm.cat.
authors.forename: O
authors.initials: O
authors.lastname: Estrada Ferrer
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Ruiz Edo
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: L-A
authors.initials: LA
authors.lastname: Hidalgo Grau
authors.affiliation: Department of Radiology, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Abadal Prades
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Del Bas Rubia
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Garcia Torralbo
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Heredia Budo
authors.affiliation: Department of General Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Suñol Sala
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D004239:Diverticulitis, Colonic / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D007660:Ketoprofen / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012810:Sigmoid Diseases / Q000188:drug therapy*; D014325:Tromethamine / Q000008:administration & dosage*
chemical_list: D018712:Analgesics, Non-Narcotic; D014325:Tromethamine; D000082:Acetaminophen; D007660:Ketoprofen; C118296:dexketoprofen trometamol; D007052:Ibuprofen
keywords: Acute diverticulitis; Non-antibiotic; Outpatient; Sigmoid