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

In this three-part series on General Surgery, we will first explore the potential treatment options for uncomplicated diverticulitis. The guest experts are Dr Sergei Tsakanov (general surgical Fellow at Auburn District Hospital) and Dr Michael Haddock (ED consultant at Westmead Hospital).
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
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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.

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