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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, October 13, 2020

Diverticulitis and antibiotics

First10EM - By Justin Morgensten - October 12, 2020
"We have discussed evidence that antibiotics may not help diverticulitis multiple times on this blog (for example here and here). After another negative RCT, it is time to tackle the difficult question of how much evidence we need to overturn long standing medical practices.
The paper
The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832
The Results
Out of 459 patients screened for eligibility, 180 were randomized in the trial. 
There was no statistical difference in the primary outcome of hospital length of stay. Median length of stay was 40 hours in the antibiotic group (95% CI 24-58) and 46 hours in the placebo group (95% CI 27-60).
There also weren’t any differences in the secondary outcomes. 2 patients needed procedural interventions in the antibiotic group, as compared to 0 in the placebo group. 1 patient in the antibiotic group died as compared to 0 in the placebo group. Readmission within 1 week occurred in 6% of the antibiotic group as compared to 1% of the placebo group. Overall adverse events were exactly equal."