# Acute Uncomplicated Diverticulitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Amoxicillin + clavulanic acid — 1000 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ciprofloxacin — 500 mg — oral.solid - Metronidazole — 500 mg — oral.solid ## Complete treatment card ```text ACUTE UNCOMPLICATED DIVERTICULITIS 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 Review status: REVIEWED against 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) (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 !! 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] Adult 1 g (875/125 mg) twice daily x 7-10 days Peds Specialist pediatric gastroenterology referral if suspected Source ACG Clinical Guideline: Management of Diverticulitis 2022 Why Broad-spectrum oral coverage for colonic anaerobes and Gram-negative bacilli Caution 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. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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 [1 of 2 - GIVE ALL TOGETHER] Adult 500 mg twice daily combined with Metronidazole 500 mg 3 times daily x 7-10 days Peds Not routinely used in children AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. 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 Caution Must be combined with Metronidazole for anaerobic coverage. There are FDA black box warnings for tendonitis, tendon rupture, and peripheral neuropathy. 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 500MG 10 F.C.TAB. EGPI > SEA PHARM 20.00 EGP (2.00/unit) CIPROQUIN 500MG 10 F.C. TAB. UNIPHARMA 50.00 EGP (5.00/unit) CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS. ORGANOPHARMA > ORGANO 63.00 EGP (6.30/unit) CIPROFAR 500MG 10 F.C.TAB. PHARCO 69.00 EGP (6.90/unit) CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS. MASH PREMIERE 48.00 EGP HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP 4. METRONIDAZOLE [2 of 2 - GIVE ALL TOGETHER] Adult 500 mg 3 times daily combined with Ciprofloxacin 500 mg twice daily x 7-10 days Peds Specialist pediatric use only 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. Caution 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. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/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 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)