# Diverticular disease (diverticulosis/diverticulitis) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023, Metronidazole monograph, PDF page index 306 (printed p297) for the 500 mg every 8 hours regimen; the ciprofloxacin pairing for acute diverticulitis is from the Ciprofloxacin monograph, PDF page index 373 (printed p364): "Intra-abdominal infection (including perforated appendix, appendiceal abscess, acute diverticulitis, acute cholecystitis), community-acquired: Note: For empiric therapy, usually administered in combination with metronidazole. Oral: 500 mg every 12 hours". · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Metronidazole monograph (chapter PDF p307) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023, Metronidazole monograph, PDF page index 306 (printed p297) for the 500 mg every 8 hours regimen; the ciprofloxacin pairing for acute diverticulitis is from the Ciprofloxacin monograph, PDF page index 373 (printed p364): "Intra-abdominal infection (including perforated appendix, appendiceal abscess, acute diverticulitis, acute cholecystitis), community-acquired: Note: For empiric therapy, usually administered in combination with metronidazole. Oral: 500 mg every 12 hours". - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374) - Diverticular Disease of the Colon - disease-level clinical article (diverticular-disease-clinical.txt) - MSF Essential Drugs 2024 (paracetamol oral monograph) - Diverticular disease of the colon - disease-level clinical article (diverticular-disease-full.txt) ## Treatment metadata - Ciprofloxacin — oral.solid - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid - Metronidazole — oral.solid ## Complete treatment card ```text DIVERTICULAR DISEASE (DIVERTICULOSIS/DIVERTICULITIS) Sources: Egyptian National Drug Formulary - Antimicrobial 2023, Metronidazole monograph, PDF page index 306 (printed p297) for the 500 mg every 8 hours regimen; the ciprofloxacin pairing for acute diverticulitis is from the Ciprofloxacin monograph, PDF page index 373 (printed p364): "Intra-abdominal infection (including perforated appendix, appendiceal abscess, acute diverticulitis, acute cholecystitis), community-acquired: Note: For empiric therapy, usually administered in combination with metronidazole. Oral: 500 mg every 12 hours". · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Metronidazole monograph (chapter PDF p307) Review status: REVIEWED against Egyptian National Drug Formulary - Antimicrobial 2023, Metronidazole monograph, PDF page index 306 (printed p297) for the 500 mg every 8 hours regimen; the ciprofloxacin pairing for acute diverticulitis is from the Ciprofloxacin monograph, PDF page index 373 (printed p364): "Intra-abdominal infection (including perforated appendix, appendiceal abscess, acute diverticulitis, acute cholecystitis), community-acquired: Note: For empiric therapy, usually administered in combination with metronidazole. Oral: 500 mg every 12 hours"., Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374), Diverticular Disease of the Colon - disease-level clinical article (diverticular-disease- clinical.txt), MSF Essential Drugs 2024 (paracetamol oral monograph), Diverticular disease of the colon - disease-level clinical article (diverticular-disease-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Diverticulosis itself is usually silent, with no reliable symptom pointing to its presence [diverticulosis] - Fever with abdominal pain, most often in the left lower quadrant, raises suspicion for acute diverticulitis [abdominal pain · fever] - Left lower quadrant pain is the most frequent presenting symptom, seen in 70% of cases [abdominal pain · left lower quadrant pain] - Complicated disease can bring diffuse abdominal pain, fecaluria, pneumaturia, or peritonitis with signs of sepsis [abdominal pain · sepsis] SIGNS - what you find (3) - Abdominal distension may be seen on exam [abdominal distension] - Lower abdominal tenderness, typically on the left, is a common exam finding [abdominal pain · lower abdominal pain] - Localized or diffuse peritoneal signs such as involuntary guarding and rebound tenderness can be present [guarding · peritoneal signs · rebound tenderness] TESTS (6) - Labs typically show a raised white cell count and elevated CRP - IV-contrast CT of the abdomen and pelvis is the reference imaging test, running about 98% to 99% sensitive and 99% to 100% specific - Colonic wall thickening with fat stranding on CT fits uncomplicated diverticulitis - A phlegmon, abscess, free air, or fistula on CT signals complicated disease - Repeat CT is warranted if complications are suspected or symptoms fail to improve or worsen - Colonoscopy is avoided during an acute episode because of perforation risk IF NOT THIS - what else fits (12) - Infectious or ischemic colitis is on the differential - Inflammatory bowel disease is on the differential - Irritable bowel syndrome is on the differential - Sigmoid volvulus is on the differential - Ureterolithiasis is on the differential - Ovarian torsion is on the differential - Acute cholecystitis is on the differential - Acute appendicitis is on the differential - Acute pyelonephritis is on the differential - Mesenteric ischemia is on the differential - Pelvic inflammatory disease is on the differential - Ectopic pregnancy is on the differential Source StatPearls "Diverticular Disease of the Colon" - disease-level clinical article Status traced to the source above Rx: Main treatment | Analgesia in acute uncomplicated diverticulitis - not an NSAID MAIN TREATMENT - choose one, plus any add-on marked below 1. CIPROFLOXACIN [1st line] Adult 500 mg orally every 12 hours (400 mg IV every 12 hours if intravenous therapy is needed) x 4 to 7 days following adequate source control Peds Ciprofloxacin is not first-line in children (risk of arthropathy) and diverticulitis is rare in childhood; this excerpt gives no paediatric dose for this indication. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374) Why Formulary explicitly names 'acute diverticulitis' under intra-abdominal infection dosing, given together with metronidazole for anaerobic cover - the direct guideline- backed regimen for uncomplicated diverticulitis. Caution Formulary explicitly names 'acute diverticulitis' under this combination regimen with metronidazole - do not use ciprofloxacin alone without anaerobic cover. Tendon rupture risk, more so in the elderly or with concurrent corticosteroid use; avoid first-line in children/adolescents where possible. Refer urgently for a rigid/tender abdomen or rebound tenderness suggesting peritonitis, high fever with signs of sepsis, inability to tolerate oral intake, significant rectal bleeding, or no improvement after 48-72 hours of antibiotics - these suggest complicated diverticulitis needing surgical assessment. Egypt QUINOLOROX 500MG 10 F.C. TAB. EPCI > ROXXEN 10.00 EGP (1.00/unit) ECACIPROFLOX 500 MG 20 F.C. TABS. FUTURE PHARMACEUTICAL INDU... 27.00 EGP (1.35/unit) ELMODOXACIN 250MG 10 F.C.TAB. EGPI > SEA PHARM 15.00 EGP (1.50/unit) SERVIFLOX 500MG 10 F.C.TAB. NOVARTIS 33.60 EGP (3.36/unit) CIPROMAX 500 MG 10 F.C.TABS. SPIMACO > SPI... 62.00 EGP (6.20/unit) CIPROFAR 750MG 10 F.C. TAB. PHARCO 86.00 EGP (8.60/unit) HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP CIPROMEGA XL 1000 MG 14 EXT. REL. F.C.TABS. MASH PREMIERE 128.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Diverticular Disease of the Colon - disease-level clinical article (diverticular- disease-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Hospitalization for IV antibiotics is required for patients who are febrile, unable to maintain hydration, immunocompromised, or have multiple comorbidities - not conveyed on an oral-only regimen page. RED FLAG - Hemodynamic instability or peritonitis signals complicated diverticulitis requiring emergent surgery, not oral antibiotics. RED FLAG - Failure to improve within 72 hours, or clinical worsening on treatment, requires repeat evaluation (labs and CT) to rule out evolving complications. 3. METRONIDAZOLE [add-on - not a substitute] Adult 500 mg every 8 hours, by mouth or IV, as part of a combination regimen (usually with ciprofloxacin). x 4 to 7 days following adequate source control Peds The formulary gives no paediatric diverticulitis regimen. Its general susceptible- infection dosing is a DAILY total to be divided, not a per-dose figure: oral 15 to 50 mg/kg/day in three divided doses, maximum 2,250 mg/day; IV 22.5 to 40 mg/kg/day in three or four divided doses, maximum 4,000 mg/day. Divide before giving, and cap at the stated daily maximum. Diverticular disease in a child warrants surgical/paediatric specialist involvement. Source Egyptian National Drug Formulary - Antimicrobial 2023, Metronidazole monograph, PDF page index 306 (printed p297) for the 500 mg every 8 hours regimen; the ciprofloxacin pairing for acute diverticulitis is from the Ciprofloxacin monograph, PDF page index 373 (printed p364): "Intra-abdominal infection (including perforated appendix, appendiceal abscess, acute diverticulitis, acute cholecystitis), community-acquired: Note: For empiric therapy, usually administered in combination with metronidazole. Oral: 500 mg every 12 hours". Why Added to ciprofloxacin for anaerobic coverage, as the ciprofloxacin monograph itself specifies ('usually administered in combination with metronidazole'); matching intra- abdominal-infection dosing and duration. Caution No alcohol during treatment or for 3 days after stopping; avoid within 2 weeks of disulfiram. Paediatric figures are daily totals with a ceiling: maximum 2,250 mg/day oral, 4,000 mg/day IV. Given together with ciprofloxacin for anaerobic cover, not as a substitute for it. Same red flags as above - refer urgently for peritonism, sepsis, inability to tolerate oral intake, major rectal bleeding, or failure to improve after 48-72 hours. Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023. Egypt TRICHOGYL 250 MG 20 TAB. EL NASR 4.35 EGP (0.22/unit) DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) FLAGICURE 250MG 20 TAB. KAHIRA 7.00 EGP (0.35/unit) METRONIDAZOLE-MUP 250 MG 20 F.C. TABS. MUP 11.00 EGP (0.55/unit) METROZOLE 250MG 20 TAB. MEMPHIS 20.00 EGP (1.00/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid ANALGESIA IN ACUTE UNCOMPLICATED DIVERTICULITIS - NOT AN NSAID - give alongside 4. PARACETAMOL [add-on - not a substitute] Adult 1 g 3 or 4 times daily (maximum 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (MSF: child under 1 month, 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily); child 1 month and over, 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 (paracetamol oral monograph) Why The disease article is explicit that pain in acute uncomplicated diverticulitis should be controlled with paracetamol and NOT with NSAIDs, which are associated with perforation. The card carried two antibiotics and no analgesic at all, leaving the prescriber to reach for an NSAID. Caution Administer with caution to patients with hepatic impairment. Do not exceed indicated doses, especially in children and older patients. Paracetamol intoxications are severe (hepatic cytolysis). Paracetamol has no anti-inflammatory properties. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)