Category: Gastrointestional
Keywords: acute diverticulitis (PubMed Search)
Posted: 10/11/2023 by Neeraja Murali, DO, MPH
(Updated: 4/28/2024)
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Diverticular disease is a common condition, with 60% of individuals over age 80 and 30% of those over age 45 (!) having diverticula. Recent estimates show that 10-25% of this subset with suffer at least one episode of acute diverticulitis in their lifetime. Fortunately, the majority of these cases are uncomplicated. This study provides evidence that outpatient treatment of acute diverticulitis is reasonable.
Study Design:
The DINAMO study was a multicenter randomized open-label non-inferiority trial evaluating the utility of antitbiotics in uncomplicated diverticulitis. The study included adult patients with uncomplicated diverticulitis without significant comorbities. The diagnosis was based on modified Neff classification with patients with a mNeff of 0 being included. Eligible patients were randomized to one of two treatment groups:
1) 600 mg ibuprofen q 8 h alternating with 1000 mg of acetaminophen q 8 h x7 d (Exerimental arm) OR
2) 875/125 mg amoxicillin/clavulanate q 8 h x 7 d in addition to the above (Control arm)
Outcomes of interest and Results:
Any patients who returned to the hospital underwent repeat CT. Primary of outcome of interest was admission to the hospital on revisit, with secondary outcomes being revisit itself, follow up, pain control, and recovery
There was no statistically significant difference in any of these (for numbers, please refer to article 1 linked below); further, no patients required emergency surgery.
Implications:
There is a low likelihood ot treatment failure when antibiotics are avoided in acute uncomplicated diverticulitis. This study finds this treatment regimen ot be noninferior to antibiotic treatment in terms of hospital admission, revisit rates, and recovery. Consider this treatment regimen in eligible patients.
https://journals.lww.com/annalsofsurgery/fulltext/2021/11000/efficacy_and_safety_of_nonantibiotic_outpatient.37.aspx
https://onlinelibrary.wiley.com/doi/10.1111/codi.12449
