Patient and Physician Preferences for Antibiotics in Acute Uncomplicated Diverticulitis: A Delphi Consensus Process to Generate Noninferiority Margins.
Dis Colon Rectum
; 64(1): 119-127, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-33093297
ABSTRACT
BACKGROUND:
Despite the existing evidence, the omission of antibiotics in the management of acute uncomplicated diverticulitis has not gained widespread acceptance.OBJECTIVE:
This study aims to incorporate the input of both patients and physicians on the omission of antibiotics in uncomplicated diverticulitis to generate noninferiority margins for 3 outcomes.DESIGN:
This was a mixed-methods study, including in-person interviews with patients and a Delphi process with physicians. SETTINGS North American patients and physicians participated. PATIENTS Consecutive patients undergoing colonoscopy, 40% of whom had a previous history of diverticulitis, were selected.INTERVENTIONS:
Informational video (for patients) and evidence summaries (for physicians) regarding antibiotics in diverticulitis were reviewed. MAIN OUTCOMESMEASURES:
Noninferiority margins were generated for time to reach full recovery, persistent diverticulitis, and progression to complicated diverticulitis in the context of a nonantibiotic strategy. Consensus was defined as an interquartile range <2.5.RESULTS:
Fifty patients participated in this study. To avoid antibiotics, patients were willing to accept up to 5.0 (3.0-7.0) days longer to reach full recovery, up to an absolute increase of 4.0% (4.0-6.0) in the risk of developing persistent diverticulitis, and up to an absolute increase of 2.0% (0-3.8) in the risk of progressing to complicated diverticulitis. A total of 55 physicians participated in the Delphi (round 1 response rate = 94.8%; round 2 response rate = 100%). Consensus noninferiority margins were generated for persistent diverticulitis (4.0%, 4.0-5.0) and progression to complicated diverticulitis (3.0%, 2.0-3.0), but could not be generated for time to reach full recovery (5.0 days, 3.5-7.0).LIMITATIONS:
Patients were recruited from a single institution, and Delphi participants were invited and not randomly selected.CONCLUSION:
Noninferiority margins were generated for 3 important outcomes after the treatment of acute uncomplicated diverticulitis in the context of a nonantibiotic strategy.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Atitude do Pessoal de Saúde
/
Doença Diverticular do Colo
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Preferência do Paciente
/
Antibacterianos
Tipo de estudo:
Etiology_studies
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Guideline
/
Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article