急性无并发症憩室炎治疗的当前趋势。

IF 1.1 4区 医学 Q3 SURGERY Journal of Laparoendoscopic & Advanced Surgical Techniques Pub Date : 2024-11-01 Epub Date: 2024-10-23 DOI:10.1089/lap.2024.0330
Kathryn Cavallo, R Natalie Reed, James Edward Duncan, Fred Brody
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引用次数: 0

摘要

导言:在美国和发达国家,急性憩室炎是一种严重的疾病负担。本文探讨了当前治疗急性憩室炎的趋势,并重点分析了抗生素在门诊急性无并发症病例中的应用。方法:对文献中的随机对照试验(RCT)进行了审查,以了解抗生素治疗憩室炎的最佳实践和建议。时间段包括 2000 年之后的相关 RCT。结果:最近有四项 RCT 研究了急性无并发症憩室炎抗生素的使用情况。AVOD 研究是一项对住院患者进行抗生素治疗或单独静脉输液治疗的 RCT,结果表明非抗生素治疗在恢复、并发症发生率或复发率方面均无劣势。DIABLO 试验对首次入院的急性无并发症憩室炎患者随机进行了抗生素治疗或支持治疗,结果发现两组患者的发病率或死亡率没有差异,而接受抗生素治疗的患者住院时间更长。DINAMO研究对门诊患者进行了检查,结果发现,在90天的随访中,口服抗生素和不口服抗生素的患者在发病率上没有差异。STAND 研究是这四项研究中唯一一项使用安慰剂的研究,结果发现 30 天的住院时间或其他不良反应没有差别。有鉴于此,ASCRS、AAFP 和其他协会目前建议在急性无并发症憩室炎中不要常规使用抗生素。结论:几项高质量的研究发现,急性无并发症憩室炎使用或不使用抗生素治疗的结果相似。基于这些发现,社会指南不建议对急性憩室炎常规使用抗生素。
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Current Trends in the Treatment of Acute Uncomplicated Diverticulitis.

Introduction: Acute diverticulitis represents a significant disease burden in the United States and developed world. This article examines current trends in the treatment of acute diverticulitis and concentrates on the utility of antibiotics in acute uncomplicated cases managed in the outpatient setting. Methods: The literature was reviewed for randomized controlled trials (RCTs) to discern the best practice and recommendations for antibiotics for diverticulitis. The time period included relevant RCTs after 2000. Results: Four recent RCTs examine the use of antibiotics in acute uncomplicated diverticulitis. The AVOD study was an RCT that managed inpatients with either antibiotics or IV fluids alone and demonstrated non-inferiority of non-antibiotic management with respect to recovery, complication rates, or recurrence. The DIABLO trial randomized first episodes of acute uncomplicated diverticulitis admitted to the hospital with antibiotics or supportive care and found no difference in morbidity or mortality between the two groups and longer hospital stay for patients treated with antibiotics. The DINAMO study examined outpatients managed with antibiotics by mouth or without and found no difference in morbidity in 90 day follow-up. The STAND study was the only of these four to use a placebo and found no difference between hospital stay or other adverse events at 30 days. In response to this, the ASCRS, AAFP and other societies now recommend against the routine use of antibiotics in acute uncomplicated diverticulitis. Conclusions: Several quality studies found similar outcomes in cases of acute uncomplicated diverticulitis treated with or without antibiotics. Based on these findings, societal guidelines do not recommend routine antibiotics for acute diverticulitis.

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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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