Dawaa Reference

infectious

Acute Uncomplicated Diverticulitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

ACG Clinical Guideline: Management of Diverticulitis 2022 for the indication, with the dose from Egyptian National Drug Formulary - Antimicrobial 2023, Ciprofloxacin monograph (printed page 365): "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" with "Duration of therapy is for 4 to 7 days following adequate source control". The formulary's stated duration is 4 to 7 days against the 7 to 10 days given here. · ACG Clinical Guideline: Management of Diverticulitis 2022

Verified against3 documents
  • ACG Clinical Guideline: Management of Diverticulitis 2022 for the indication, with the dose from Egyptian National Drug Formulary - Antimicrobial 2023, Ciprofloxacin monograph (printed page 365): "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" with "Duration of therapy is for 4 to 7 days following adequate source control". The formulary's stated duration is 4 to 7 days against the 7 to 10 days given here.
  • ACG Clinical Guideline: Management of Diverticulitis 2022
  • Acute Uncomplicated Diverticulitis - disease-level clinical article (diverticulitis-uncomplicated-full.txt)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Diverticular Disease of the Colon" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Ciprofloxacin + Metronidazole

Rx: Main treatment | If penicillin-allergic

MAIN TREATMENT - choose one

1

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g (875/125 mg) twice daily x 7-10 days

Paediatric dose

Specialist pediatric gastroenterology referral if suspected

Dose source

ACG Clinical Guideline: Management of Diverticulitis 2022

Why

Broad-spectrum oral coverage for colonic anaerobes and Gram-negative bacilli

Cautions
  • Selective use: mild uncomplicated diverticulitis in immunocompetent patients without high-risk features may be managed conservatively without antibiotics per ACG 2022.
  • Take at start of meals to minimize GI side effects.
  • Refer to hospital if high fever, severe peritoneal signs, vomiting, or failure to improve in 48 hours.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
JULMENTIN 2X 1GM 15 TAB.JULPHAR57.50 EGP (3.83/unit)
DEXICLAVE 1 GM 10 F.C. TABS.RAMEDA > NOVELL PHARMA38.50 EGP (3.85/unit)
MACLAVEX 1 GM 14 F.C.TABS.MASH PREMIERE105.00 EGP (7.50/unit)
CLAVIMOX 1 GM 12 F.C.TABS.PHARCO130.00 EGP (10.83/unit)
MEGAMOX 1 GM 14 F.C. TABS.AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA178.00 EGP (12.71/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Acute Uncomplicated Diverticulitis - disease-level clinical article (diverticulitis-uncomplicated-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Referral or hospitalization is indicated for patients with fever, inability to maintain hydration, immunocompromise, or failure to improve within 72 hours.

IF PENICILLIN-ALLERGIC - give all together

3

CIPROFLOXACIN

If penicillin-allergic

Regimen: diverticulitis-dual

1 of 2 - GIVE ALL TOGETHER

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily combined with Metronidazole 500 mg 3 times daily x 7-10 days

Paediatric dose

Not routinely used in children

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

ACG Clinical Guideline: Management of Diverticulitis 2022 for the indication, with the dose from Egyptian National Drug Formulary - Antimicrobial 2023, Ciprofloxacin monograph (printed page 365): "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" with "Duration of therapy is for 4 to 7 days following adequate source control". The formulary's stated duration is 4 to 7 days against the 7 to 10 days given here.

Why

Second-line combination for penicillin-allergic patients

Cautions
  • Must be combined with Metronidazole for anaerobic coverage.
  • There are FDA black box warnings for tendonitis, tendon rupture, and peripheral neuropathy.
Egyptian brands
Egyptian brandManufacturerIndicative price
QUINOLOROX 500MG 10 F.C. TAB.EPCI > ROXXEN10.00 EGP (1.00/unit)
ECACIPROFLOX 500 MG 20 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN PHARMACEUTICAL27.00 EGP (1.35/unit)
ELMODOXACIN 500MG 10 F.C.TAB.EGPI > SEA PHARM20.00 EGP (2.00/unit)
CIPROQUIN 500MG 10 F.C. TAB.UNIPHARMA50.00 EGP (5.00/unit)
CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS.ORGANOPHARMA > ORGANO63.00 EGP (6.30/unit)
CIPROFAR 500MG 10 F.C.TAB.PHARCO69.00 EGP (6.90/unit)
CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS.MASH PREMIERE48.00 EGP
HEROXACIN 500MG 10 SCORED F.C. TAB.EGPI > HERO PHARM69.00 EGP
4

METRONIDAZOLE

If penicillin-allergic

Regimen: diverticulitis-dual

2 of 2 - GIVE ALL TOGETHER

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg 3 times daily combined with Ciprofloxacin 500 mg twice daily x 7-10 days

Paediatric dose

Specialist pediatric use only

Dose source

ACG Clinical Guideline: Management of Diverticulitis 2022

Why

Antibiotic providing anaerobic gut flora coverage, paired with a fluoroquinolone to give combined aerobic and anaerobic coverage for acute uncomplicated diverticulitis.

Cautions
  • Provides anaerobic coverage when paired with fluoroquinolone.
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.