Dawaa Reference

acute

Diverticular disease (diverticulosis/diverticulitis)

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

Evidence status

Checked against the sources named below

Sources3 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 against5 documents
  • 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)

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.

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

Formoral.solid

Adult dose and duration

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

Paediatric dose

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.

Dose 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.

Cautions
  • 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.
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 250MG 10 F.C.TAB.EGPI > SEA PHARM15.00 EGP (1.50/unit)
SERVIFLOX 500MG 10 F.C.TAB.NOVARTIS33.60 EGP (3.36/unit)
CIPROMAX 500 MG 10 F.C.TABS.SPIMACO > SPIMACO-EGYPT62.00 EGP (6.20/unit)
CIPROFAR 750MG 10 F.C. TAB.PHARCO86.00 EGP (8.60/unit)
HEROXACIN 500MG 10 SCORED F.C. TAB.EGPI > HERO PHARM69.00 EGP
CIPROMEGA XL 1000 MG 14 EXT. REL. F.C.TABS.MASH PREMIERE128.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • 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

Formoral.solid

Adult dose and duration

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

Paediatric dose

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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRICHOGYL 250 MG 20 TAB.EL NASR4.35 EGP (0.22/unit)
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
FLAGICURE 250MG 20 TAB.KAHIRA7.00 EGP (0.35/unit)
METRONIDAZOLE-MUP 250 MG 20 F.C. TABS.MUP11.00 EGP (0.55/unit)
METROZOLE 250MG 20 TAB.MEMPHIS20.00 EGP (1.00/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/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

ANALGESIA IN ACUTE UNCOMPLICATED DIVERTICULITIS - NOT AN NSAID - give alongside

4

PARACETAMOL

Analgesia in acute uncomplicated diverticulitis - not an NSAID

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (maximum 4 g daily)

Paediatric dose

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).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

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