Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 2017¹, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice.

[Tratamiento ambulatorio de la diverticulitis aguda no complicada. Análisis de nuestra experiencia]

Objective

Analyze the safety and efficacy of the outpatient treatment of uncomplicated acute diverticulitis and a costs analysis.

Method

We conducted a prospective, non-randomized study between June 2014 and June 2017. We included all patients diagnosed of uncomplicated acute diverticulitis based on clinical and abdominal computed tomography scan in the Emergency Department of the University Hospital San Juan de Alicante (Spain). Outpatient treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanate or ciprofloxacin and metronidazole in patients with betalactamic allergy), liquid diet for 72 h and analgesics. Costs were evaluated according to the Law of Rates of Valencian Community.

Results

Ninety patients were included, 49 females and 41 males with a median age of 56 years. Success rate was 95.5% (n = 86) requiring hospital admission 4 patients (4.5%). Antibiotic treatment was amoxicillin-clavulanate in 82 patients (91.1%) and ciprofloxacin and metronidazole in 8 (8.9%). Cost savings per patient was approximately 1985 € comparing with hypothetically all inpatient treatment.

Conclusions

Outpatient treatment of uncomplicated acute diverticulitis can be performed successfully in most patients allowing an important cost savings.