Episode 10 - General Surgery: Part 1 - Uncomplicated Diverticulitis & Antibiotics

Theme:
General Surgery

Participants:

Dr Michael Haddock (ED consultant), Dr Sergei Tsakanov (general surgical Fellow), Edgardo Solis (general surgical registrar), Shreyas Iyer, Samoda Wilegoda Mudalige, Kit Rowe, Caroline Tyers, Harry Hong and Yelise Foon.

Discussion:
Jaung, R., Nisbet, S., Gosselink, M., Di Re, A., Keane, C., & Lin, A. et al. (2021). Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clinical Gastroenterology And Hepatology, 19(3), 503-510.e1. https://doi.org/10.1016/j.cgh.2020.03.049.

Summary:

• This was the first randomized-controlled trial comparing antibiotics to no antibiotics in uncomplicated acute diverticulitis with a placebo control.
• The primary outcome assessed was the length of stay in hospital, with secondary outcomes including withdrawal rates from the study, the occurrence of adverse events, readmission to hospital within 1 week and 30 days, procedural interventions, change in the serial inflammatory markers, and patient-reported pain scores at 12 and 24 hours from admission.
• Exclusion criteria included meeting 2 or more of the SIRS criteria (including fever, and WCC <4 or >12), and inability to give consent or answer symptom-related questions (due to language barrier or cognitive impairment), amongst others.
• The study found that placebo was not inferior to antibiotics for uncomplicated acute diverticulitis regarding hospital length of stay.
• There was also no significant difference between groups with regards to adverse events and readmission to hospital within 1 week and 30 days (although the power of the study was not high enough to definitively answer these outcomes).

Take-Home Points:

• There may be a role for treating uncomplicated acute diverticulitis without antibiotics, although this is not the standard of practice in Australia yet.
• If these patients are treated without antibiotics, there would need to be an adequate follow-up plan (to account for patients potentially deteriorating and developing a complication of diverticulitis).
• This is a growing area of research; with practices varying between institutions.

References:

• Chabok A, Pahlman L, Haapaniemi S, Smedh K, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery. 2012;99(4):540-540.
• Daniels L, Unlu C, de Korte N, et al. Randomised clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg.2017; 104: 52-61.

Credits:
This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta.

Music/Sound Effects

• Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.
• Night Sky by Leonell Cassio ft. Julia Mihevc | https://soundcloud.com/leonellcassio, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.
• Sound effects from https://www.free-stock-music.com.
• Timeless by Helkimer | https://soundcloud.com/helkimer, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
• What You Want by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.

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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.

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