The STAND Study (Selective Treatment with Antibiotics for Non-complicated Diverticulitis)

Abstract

PURPOSE/BACKGROUND: Antibiotic treatment is still widely regarded as standard care in the management of uncomplicated acute diverticulitis (UAD). This practice is based on low level evidence and has been challenged by two randomised trials which were not placebo-controlled. The STAND study aimed to demonstrate the non-inferiority of placebo versus antibiotic treatment for the management of UAD. METHODS/INTERVENTIONS: This international (New Zealand and Australia), multi-centre, placebo-controlled and double-blinded randomized control trial recruited participants with CT scan-proven Hinchey 1a UAD to receive antibiotics or placebo. The primary endpoint was length of hospital admission and the main secondary endpoints were occurrence of adverse events and readmission within one week and 30 days. RESULTS/OUTCOMES: A total of 180 participants were randomized to receive antibiotics (n = 85) or placebo (n = 95). Length of admission was not prolonged in the placebo group when compared with the antibiotic group; median 45.8 (95% CI 26.5-60.2) versus 40.0 (95% CI 24.4-57.6) hours respectively (P = 0.2). The difference between medians (placebo – antibiotics) was 5.9 (95% CI -3.7-15.5) hours. No significant differences were found for the main secondary endpoints between the two groups: adverse events (12% vs 12%, P = 1.0), readmission within one week (6% vs 1%; P = 0.1) and 30 days (6% vs 11%; P = 0.3) CONCLUSION/DISCUSSION: Foregoing antibiotic treatment did not pro-long length of hospital admission. This result provides arguably the strongest evidence to date in support of omitting antibiotics in selected patients presenting with UAD.