Acute uncomplicated diverticulitis managed without antibiotics – difficult to introduce a new treatment protocol but few complications

Figures & data

Table 1. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Age over 18 years	Signs of other diagnosis
Any of following diagnose codes:	Receiving immunosuppressive therapy
K57.3 or K57.9	Pregnancy
K57.2 or K57.8 without signs of complicated disease	Signs of complicated diverticulitis on CT with abscess, fistula or free air in abdomen or pelvis
Acute lower abdominal pain w tenderness	Ongoing antibiotic therapy
Body temperature ≥38 °C, self-reported or measured at hospital	Affected general condition, general peritonitis, sepsis
Raised WBC and CRP level, or at least increased WBC if short history

WBC: white blood cell count; CRP: C-reactive protein; CT: computed tomography.

Figure 1. Flowchart describing included and excluded patients.

Table 2a. Background characteristics of the whole study population.

	Total (n = 132)	Antibiotics (n = 101)	No antibiotics (n = 31)	p
Age (years)	63 (48–72)	63 (47–72)	63 (59–70)	.32
Female sex	84 (64)	62 (61)	22 (71)	.33
BMI (kg/m^2)	26.8 (23.9–30.5)	26.8 (23.9–30.9)	26.8 (24.7–30.1)	.83
CRP (mg/L)	64 (29–106)	79 (29–136)	49 (24–91)	.09
WBC (×10^9 cells/L)	12.3 (10.1–14.7)	12.2 (10.0–15.1)	12.8 (10.5–14.4)	.71
Body temperature (°C)	37.5 (36.8–38.1)	37.5 (37.0–38.2)	37.2 (36.7–37.8)	.09
Previous diverticulitis (n; %)	33 (25)	26 (26)	7 (23)	.72
Any comorbidity (n; %)	73 (55)	61 (60)	12 (39)	.03
Cardiovascular disease	51 (39)	43 (43)	8 (26)	.10
Pulmonary disease	19 (14)	17 (17)	2 (6)	.15
Renal disease	4 (3)	4 (4)	0 (0)	.26
Endocrine disease	24 (18)	19 (19)	5 (16)	.74
Hematological disease	4 (3)	4 (4)	0 (0)	.26
Rheumatic disease	14 (11)	13 (13)	1 (3)	.13
Neurological disease	7 (5)	4 (4)	3 (10)	.22
Other disease	7 (5)	6 (6)	1 (3)	.56

BMI: body mass index; WBC: white blood cell count; CRP: C-reactive protein.

Data presented as median (IQR) or as absolute frequency (relative frequency).

Table 2b. Background characteristics in acute uncomplicated diverticulitis patients after protocol introduction.

	Total (n = 50)	Antibiotics (n = 19)	No antibiotics (n = 31)	p
Age (years)	62 (51–70)	63 (48–68)	63 (59–70)	.47
Female sex (n; %)	29 (62)	9 (47)	20 (71)	.10
BMI (kg/m^2)	25.9 (23.9–29.5)	25.4 (23.8–28.9)	26.3 (24.0–30.1)	.72
CRP (mg/L)	61 (33–157)	117 (48–197)	52 (34–102)	.008
WBC (×10^9 cells/L)	12.8 (11.0–14.6)	12.8 (10.9–15.0)	12.8 (10.4–14.0)	.79
Body temperature (°C)	37.4 (36.7–37.9)	37.9 (37.4–38.1)	37.2 (36.7–37.8)	.09
Previous diverticulitis (n; %)	15 (32)	8 (42)	7 (25)	.22
Comorbidity (n; %)	18 (38)	9 (47)	9 (32)	.29

BMI: body mass index; WBC: white blood cell count; CRP: C-reactive protein.

Data presented as median (IQR) or as absolute frequency (relative frequency).

Table 3. Findings at admission and hospital length of stay.

	Total (n = 132)	Antibiotics (n = 101)	No antibiotics (n = 31)	p
Duration of symptoms (days)	2 (1–3)	2 (1–3)	2 (1–3)	.86
Low abdominal pain (n; %)	117 (89)	87 (86)	30 (97)	.10
Fever (n; %)	72 (55)	58 (57)	14 (45)	.23
Obstipation (n; %)	19 (14)	15 (15)	4 (13)	.79
Diarrhea (n; %)	37 (28)	28 (28)	9 (29)	.89
Urgency to urination (n; %)	21 (16)	17 (17)	4 (13)	.60
Vomiting (n; %)	7 (5)	7 (7)	0 (0)	.13
Blood in stool (n; %)	11 (8)	10 (10)	1 (3)	.24
CT scan performed (n; %)	106 (80)	79 (78)	27 (87)	.28
Findings consistent with acute  uncomplicated diverticulitis	105 (99)	78 (99)	27 (100)	.56
Hospital length of stay (days)	3 (2–4)	3 (2–4)	2 (1–3)	.004

CT: computed tomography.

Data presented as median (IQR) or as absolute frequency (relative frequency).

Table 4. Complications following an episode of acute uncomplicated diverticulitis within 12 months.

	Total (n = 132)	Antibiotics (n = 101)	No antibiotics (n = 31)	p
Any complication	18 (14)	16 (16)	2 (6)	.18
Abscess (n; %)	0 (0)	0 (0)	0 (0)	–
Perforation (n; %)	2 (2)	2 (2)	0	.43
Stenosis (n; %)	0	0	0	–
Sepsis (n; %)	0	0	0	–
Fistula (n; %)	1 (0.8)	1 (1)	0	.58
Recurrence (n; %)	18 (14)	16 (16)	2 (6)	.18

Data presented as absolute number (relative frequency).