title: Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study.
abstract: OBJECTIVE
  This study aimed to evaluate the implementation of nonantibiotic management of acute uncomplicated diverticulitis at a large university hospital in Norway with regard to management failure, disease recurrence and complications.
  
  
  METHODS
  On 1 January 2013 we implemented a new policy for the management of acute uncomplicated diverticulitis without antibiotics. Antibiotic treatment was only provided in the case of defined criteria. All patients admitted from 1 January 2013 to 30 June 2014 with a CT-verified, left-sided, acute uncomplicated diverticulitis were included in the study and evaluated retrospectively, with 12 months' follow-up.
  
  
  RESULTS
  Of 244 admissions with acute uncomplicated diverticulitis, 177 (73%) were managed without antibiotics. Among these there were seven (4%) management failures, including five patients in whom a deteriorating clinical picture prompted antibiotic treatment and two readmissions within 1 month due to persisting symptoms. The only complication in this group was one fistula (< 1%). Eight (5%) patients had a recurrence of acute diverticulitis requiring hospital care and two (1%) underwent elective surgery within the first year. Twenty (8%) patients met predefined exemption criteria and received antibiotics from admission, six (30%) of whom developed complications. The recurrence rate in this group was 10% and none had surgery performed. The 47 (20%) policy violators treated with antibiotics from admission had no complications. Their recurrence rate was 11% and one (2%) patient underwent elective surgery.
  
  
  CONCLUSIONS
  This study confirms that nonantibiotic management of acute uncomplicated diverticulitis is safe and feasible. Most complications occurred in a small group of high-risk patients treated with antibiotics.
authors.affiliation: Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: N D
authors.initials: ND
authors.lastname: Brochmann
authors.affiliation: Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway. josc@ahus.no.|Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway. josc@ahus.no.
authors.forename: J K
authors.initials: JK
authors.lastname: Schultz
authors.affiliation: Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.
authors.forename: G S
authors.initials: GS
authors.lastname: Jakobsen
authors.affiliation: Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Øresland
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents; D000072700:Conservative Treatment / Q000379:methods*; D004238:Diverticulitis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Diverticulitis; antibiotics; colonic; diverticular disease; nonantibiotic management