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Isacson D, Smedh K, Nikberg M, et al. Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis. Br J Surg. 2019 Aug 6. doi: 10.1002/bjs.11239. (Original study)
Abstract

BACKGROUND: The aim of this study was to assess the long-term results in patients with uncomplicated diverticulitis who had participated in the Antibiotics in Acute Uncomplicated Diverticulitis (AVOD) RCT, which randomized patients with CT-verified left-sided acute uncomplicated diverticulitis to management without or with antibiotics.

METHODS: The medical records of patients who had participated in the AVOD trial were reviewed for long-term results such as recurrences, complications and surgery. Quality-of-life questionnaires (EQ-5D™) were sent to patients, who were also contacted by telephone. Descriptive statistics were used for the analysis of clinical outcomes.

RESULTS: A total of 556 of the 623 patients (89·2 per cent) were followed up for a median of 11 years. There were no differences between the no-antibiotic and antibiotic group in recurrences (both 31·3 per cent; P = 0·986), complications (4·4 versus 5·0 per cent; P = 0·737), surgery for diverticulitis (6·2 versus 7·1 per cent; P = 0·719) or colorectal cancer (0·4 versus 2·1 per cent; P = 0·061). The response rate for the EQ-5D™ was 52·8 versus 45·2 per cent respectively (P = 0·030), and no differences were found between the two groups in any of the measured dimensions.

CONCLUSION: Antibiotic avoidance for uncomplicated diverticulitis is safe in the long term.

ANTECEDENTES: El objetivo de este estudio fue evaluar los resultados a largo plazo con respecto a las recidivas, las complicaciones, la cirugía y la calidad de vida (quality of life, QOL) en pacientes con diverticulitis no complicada que participaron en el ensayo clínico aleatorizado Antibióticos en la Diverticulitis Aguda no Complicada (Antibiotics in Acute Uncomplicated Diverticulitis, AVOD). MÉTODOS: Los pacientes con diverticulitis aguda no complicada del lado izquierdo diagnosticada mediante tomografía computarizada se aleatorizaron a los tratamientos sin o con antibióticos en el ensayo AVOD (previamente publicado). Las historias clínicas de los pacientes que participaron en el ensayo se revisaron para conocer resultados a largo plazo, tales como recidivas, complicaciones y cirugía. Se enviaron cuestionarios de calidad de vida (EQ-5D) a los pacientes a los que también se contactó por teléfono.

RESULTADOS: Un total de 556 de los 623 pacientes (89,2%) fueron seguidos durante una mediana de 11 años. No hubo diferencias en la recidiva (86 versus 88; P = 0,986), complicaciones (12 versus 14; P = 0,737), cirugía por diverticulitis (17 versus 20; P = 0,719) o cáncer colorrectal (1 versus 6; P = 0,061) entre el grupo sin antibióticos y el grupo con antibióticos. La tasa de respuesta para el EQ-5D fue de 163 frente a 142 (P = 0,030), y no se encontraron diferencias en ninguna de las dimensiones medidas entre los grupos sin antibióticos y con antibióticos. CONCLUSIÓN: El tratamiento de la diverticulitis no complicada evitando la administración de antibióticos fue seguro a largo plazo.

Ratings
Discipline Area Score
Emergency Medicine 6 / 7
Gastroenterology 6 / 7
Surgery - Gastrointestinal Coming Soon...
Comments from MORE raters

Gastroenterology rater

This study has been helpful in providing some guidance with respect antimicrobials in uncomplicated diverticulitis. The trouble with extrapolating this to the real world is that 1. patients had to have CT to exclude complications, and this is not done or required every time someone presents with suspected diverticulitis; 2. this study was undertaken in a hospital setting, and not from primary care; 3. another study referred to by the authors in the discussion suggested a benefit of antimicrobials over none; 4. it is unclear whether avoidance of antimicrobials is applicable for those with recurrent diverticulitis, or simply a single isolated episode
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