Can mild acute diverticulitis be treated as an outpatient without antibiotics?

The DINAMO Study

Current evidence indicates that the use of antibiotics in the treatment of uncomplicated AD does not seem to promote significant benefits in the evolution of patients, in addition to being associated with a higher cost.

The study studied patients with mild acute diverticulitis undergoing outpatient treatment. The main objective of the study was to assess whether patients treated with antibiotics, versus no antibiotics, would show differences in hospitalization rates, need for new medical care, evolution with complications, or pain control.

It was a multicentric and non-inferiority prospective work, including 15 Digestive System Surgery and Coloproctology services in hospitals in Spain.

Inclusion criteria



Were included patients who met all the requirements below:

Patient between 18 and 80 years old; Absence of significant comorbidities ( diabetes mellitus with target organ damage, severe cardiovascular disease in the last three months, decompensated chronic liver disease in the last three months, or end-stage renal disease); Absence of immunosuppression (active neoplastic disease, hematologic malignancy, AIDS, prolonged corticosteroid therapy, immunosuppressive therapy, transplantation, splenectomy, or
• immunodeficiency due to genetic causes);

Absence of SIRS criteria;

• Acute diverticulitis without tomographic complications;
• Absence of acute diverticulitis in the last three months;
• Absence of u antibiotic therapy only (ATB) in the last two weeks ;
• Good cognitive ability and family support.
• Procedures

  The group treated without ATB received ibuprofen (600 mg 8/8 h) and paracetamol (1 g 8/8 h) for seven days to control pain. In the control group, patients were treated with amoxicillin + clavulanate (875/125 mg 8/8 h), in addition to the same analgesic regimen as the intervention group, for seven days. In case of no response after 24 hours of observation in the emergency room, patients were admitted and excluded from the study.

  Both groups were followed, with reassessment at 2, 7, 30 and 90 days after the episode, through physical examination, clinical evolution and verification of treatment adherence. In case of clinical worsening or unsatisfactory symptomatic control, the patient was referred to the emergency room for a tomography and assessment of the need for hospitalization.Results

  In relation to the primary outcome, need to seek emergency care, the group without ATB was non-inferior to the group with ATB (3.3% versus 5.8%; 95%CI 6.32 to -1.17; p=0.19). The group using antibiotics needed to escalate antibiotic therapy in 42.8% of cases, in addition to a longer hospital stay (five days versus

• 2.5 days in patients not using ATB). In 57.9% of the patients treated without ATB, there was no worsening of the complementary exams and the patients could be kept under the same treatment.

  Patients in the ATB Group showed greater pain in the two-day reassessment, however without statistically significant difference.

  Discussion of results

The results of the study demonstrated that outpatient treatment without the use of ATB is a safe and effective option in this regard. population. The main limitation of the study was the significant number of patients excluded, due to the application of strict selection criteria. Although this measure is important to ensure the safety of patients, it can limit the external validity of the work.

The guideline of American Society of Colon and Rectal Surgeons already accepts treatment without antibiotic therapy in cases of patients with uncomplicated diverticulitis without severe comorbidities. However, this was the first prospective, multicenter, randomized study to attempt to demonstrate the non-inferiority of outpatient treatment without antibiotic therapy.

Also read: Should we operate with recurrent diverticulitis?

Conclusion

The DINAMO study demonstrates that antibiotic-free outpatient treatment for mild acute diverticulitis is “non-inferior” to antibiotic treatment, in terms of hospital admission, revision rates, or subsequent recovery. Therefore, mild acute diverticulitis can be treated as an outpatient and without antibiotics, safely and effectively, as long as the inclusion criteria used in the study are respected.

Author:



Graduated in Medicine at Universidade Federal Fluminense ⦁ Medical residency in Internal Medicine at Hospital Universitário Antônio Pedro (UFF) ⦁ Resident in Gastroenterology at Hospital Universitário Cassiano Antônio de Moraes (UFES) ⦁ Instagram: @dra.fernandaazevedo

References:

• Mora-López L, et al; DINAMO-study Group. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute

  Diverticulitis (DINAMO-study ): A Multicentre, Randomised , Open-label, Noninferiority Trial. Ann Surg. 2021 Nov 1;274(5):e435-e442. It hurts: 10.1097/SLA.0000000000005031

See more benefits of being a PEBMED Portal user: See more benefits of being a user from the PEBMED Portal:



7 days free with Whitebook Application made for you, physician, designed to bring security and objectivity to your clinical decision.



Free access to the Nursebook Access key information for your daily life such as anamnesis, semiology.



Free access to the Forum Space for the exchange of experiences and constructive comments on topics related to Medicine and Health.



Unlimited access Have access to news, studies, updates and more content written and reviewed by experts

Test your knowledge Answer our quizzes and study in a simple and fun way

Personalized content Receive by email studies, updates, new behaviors and other content segmented by specialty

The PEBMED Portal is intended for doctors and other health professionals. Our contents inform recent panoramas of medicine.

If you are interested in publishing your curriculum on the internet, connecting with patients and increasing your differentials, create a free profile on AgendarConsulta, PEBMED’s partner site.

If you are interested in more contents and courses focused on medical residency, get to know Medcel, the partner site of PEBMED

Note: This article has been indexed to our site. We do not claim legitimacy, ownership or copyright of any of the content above. To see the article at the original source Click Here