Antibiotic Treatment for Acute Uncomplicated Colonic Diverticulitis – Systematic Review and Meta-Analysis

Background Antibiotic therapy has traditionally been used to treat acute uncomplicated colonic diverticulitis. However, its efficacy is increasingly being questioned, particularly regarding patient benefit and the necessity of inpatient treatment. Aims To evaluate the effectiveness and optimal use of antibiotics in acute uncomplicated colonic diverticulitis. Methods PubMed, CENTRAL, Web of Science, and EMBASE were systematically searched. All randomised clinical trials (RCTs) on antibiotic therapy for acute uncomplicated colonic diverticulitis were included. Outcomes were treatment failure, re-interventions, and length of hospital stay, analysed using random-effects meta-analysis. Risk of bias was assessed using Cochrane RoB 2.0, and certainty of evidence was rated with GRADE. Results From 3901 records, ten RCTs were included. Six RCTs including 2478 patients compared antibiotics with omission of antibiotics. No difference was found in treatment failure (OR 0.46, 95% CI 0.13–1.58; low certainty) or length of hospital stay (MD 0.16 days, 95% CI -0.21 to 0.54; moderate certainty), while re-interventions were less frequent with antibiotics (OR 0.61, 95% CI 0.37–0.99; moderate certainty). Two RCTs including 282 patients compared prolonged with shortened antibiotic therapy and showed no differences in treatment failure (OR 0.79, 95% CI 0.38–1.63; low certainty), re-interventions (OR 0.89, 95% CI 0.52–1.52; low certainty), or length of hospital stay (MD -1.05 days, 95% CI -2.51 to 0.41; moderate certainty). Two other RCTs including 197 patients compared oral with intravenous antibiotic therapy and indicated no difference in re-interventions (OR 0.95, 95% CI 0.13–6.85; low certainty). Conclusion Antibiotics may slightly reduce re-interventions in acute uncomplicated colonic diverticulitis but show no clear benefit for treatment failure or length of stay. No preference was identified for oral versus intravenous therapy or short versus standard courses. Overall certainty of evidence ranged from low to moderate, and further high-quality RCTs are needed.