For patients with uncomplicated acute diverticulitis, forgoing antibiotic use did not increase the length of hospital stay, according to study data published in Clinical Gastroenterology and Hepatology.

The aim of the Selective Treatment with Antibiotics for Non-complicated Diverticulitis Length of Hospital Stay Unaffected by Antibiotic Omission in Uncomplicated Diverticulitis (STAND) study was to assess the outcomes of standard antibiotic treatment plans in patients hospitalized for uncomplicated acute diverticulitis. This placebo-controlled, double-blind, randomized, controlled trial was conducted at 4 sites in New Zealand and Australia. Patients were included if they had Hinchey 1a uncomplicated acute diverticulitis confirmed by computed tomography (CT) scan. Patients were randomized to either antibiotic or placebo cohorts. Data regarding demographics, medical history, clinical assessments, laboratory test results, and symptom questionnaires were collected. The primary outcome in the study was the duration of time between hospital admission and discharge. The secondary outcomes were withdrawal rates, adverse events, readmissions, procedural interventions, and change in inflammation markers and patient-reported pain scores.

Of the 180 patients included in the study, 85 were assigned to the antibiotics cohort and 95 were assigned to the placebo cohort. Baseline clinical characteristics were similar between the 2 cohorts for all measures except mean time to CT scan, which was longer in the placebo cohort compared with the antibiotic cohort (P =.01). The median duration of hospital stay was not significantly different between the 2 cohorts (P =.15) —  40.0 hours for the antibiotic cohort and 45.8 hours in the placebo cohort — even when the CT scan timing disparity was considered (P =.34).


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Secondary outcomes were also similar between the 2 cohorts, including readmission rates for both 1 week (P =.07) and 1 month (P =.3), need for procedural intervention (P =.1), mortality (P =.3), white cell count (P =.7), patient pain score at 24 hours (P =.9), and withdrawal rates (P =.8). Adverse events occurred in 12% of patients in both cohorts (P =.97).

Limitations of the study included the inability to assess significant differences when variance in hospital stays was less than 24 hours, the lack of data to assess long-term significant differences between the 2 cohorts, and the inability to generalize results to other populations.

The researchers concluded that “[t]his study demonstrates that the use of placebo is non-inferior to antibiotics when comparing length of hospital admission context.”

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Reference

Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics do not reduce length of hospital stay for uncomplicated diverticulitis in a pragmatic double-blind randomized trial [published online March 30, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.03.049