Volume 99, Issue 4 p. 532-539
Randomized Clinical Trial

Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis

A. Chabok

A. Chabok

Colorectal Unit, Department of Surgery, and Centre for Clinical Research Uppsala University, Västmanlands Hospital, Västerås, Sweden

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L. Påhlman

L. Påhlman

Colorectal Unit, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

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F. Hjern

F. Hjern

Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden

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S. Haapaniemi

S. Haapaniemi

Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden

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K. Smedh

Corresponding Author

K. Smedh

Colorectal Unit, Department of Surgery, and Centre for Clinical Research Uppsala University, Västmanlands Hospital, Västerås, Sweden

Department of Surgery, Central Hospital, SE-72189 Västerås, Sweden.Search for more papers by this author
for the AVOD Study Group

for the AVOD Study Group

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First published: 30 January 2012
Citations: 360

Presented to the Fifth Annual Meeting of the European Society of Coloproctology, Sorrento, Italy, September 2010; published in abstract form as Colorectal Dis 2011; 12(Suppl S3): 1

Abstract

Background:

The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. The aim was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis, with the endpoint of recovery without complications after 12 months of follow-up.

Methods:

This multicentre randomized trial involving ten surgical departments in Sweden and one in Iceland recruited 623 patients with computed tomography-verified acute uncomplicated left-sided diverticulitis. Patients were randomized to treatment with (314 patients) or without (309 patients) antibiotics.

Results:

Age, sex, body mass index, co-morbidities, body temperature, white blood cell count and C-reactive protein level on admission were similar in the two groups. Complications such as perforation or abscess formation were found in six patients (1·9 per cent) who received no antibiotics and in three (1·0 per cent) who were treated with antibiotics (P = 0·302). The median hospital stay was 3 days in both groups. Recurrent diverticulitis necessitating readmission to hospital at the 1-year follow-up was similar in the two groups (16 per cent, P = 0·881).

Conclusion:

Antibiotic treatment for acute uncomplicated diverticulitis neither accelerates recovery nor prevents complications or recurrence. It should be reserved for the treatment of complicated diverticulitis. Registration number: NCT01008488 (http://www.clinicaltrials.gov). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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