{ "schema_version": 1, "kind": "condition", "id": "diverticular-disease", "name": "Diverticular disease (diverticulosis/diverticulitis)", "category": "acute", "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", "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)", "verified_date": "2026-08", "treatments": [ { "id": 602, "generic": "Ciprofloxacin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "500 mg orally every 12 hours (400 mg IV every 12 hours if intravenous therapy is needed)", "adult_duration": "4 to 7 days following adequate source control", "dose_source": "Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ciprofloxacin monograph (chapter PDF p374)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "QUINOLOROX 500MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EPCI > ROXXEN", "price_egp": 10.0, "pack_count": 10, "unit_price": 1.0, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ECACIPROFLOX 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN PHARMACEUTICAL", "price_egp": 27.0, "pack_count": 20, "unit_price": 1.35, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELMODOXACIN 250MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > SEA PHARM", "price_egp": 15.0, "pack_count": 10, "unit_price": 1.5, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SERVIFLOX 500MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 33.6, "pack_count": 10, "unit_price": 3.36, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CIPROMAX 500 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SPIMACO > SPIMACO-EGYPT", "price_egp": 62.0, "pack_count": 10, "unit_price": 6.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CIPROFAR 750MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 86.0, "pack_count": 10, "unit_price": 8.6, "strength_mg": 750.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HEROXACIN 500MG 10 SCORED F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > HERO PHARM", "price_egp": 69.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CIPROMEGA XL 1000 MG 14 EXT. REL. F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 128.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diverticular-disease" }, { "id": 604, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Diverticular Disease of the Colon - disease-level clinical article (diverticular-disease-clinical.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "diverticular-disease" }, { "id": 605, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (maximum 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (paracetamol oral monograph)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "diverticular-disease" }, { "id": 603, "generic": "Metronidazole", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": null, "adult_dose": "500 mg every 8 hours, by mouth or IV, as part of a combination regimen (usually with ciprofloxacin).", "adult_duration": "4 to 7 days following adequate source control", "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\".", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TRICHOGYL 250 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 4.35, "pack_count": 20, "unit_price": 0.22, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUMOZOL 500MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 7.0, "pack_count": 20, "unit_price": 0.35, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAGICURE 250MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 7.0, "pack_count": 20, "unit_price": 0.35, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METRONIDAZOLE-MUP 250 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 11.0, "pack_count": 20, "unit_price": 0.55, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROZOLE 250MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 20.0, "pack_count": 20, "unit_price": 1.0, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRICHOGYL 500MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 15.0, "pack_count": 12, "unit_price": 1.25, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GEDAZOLE 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROGYPTON 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUMOZOL 125MG/5ML SUSP. 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 5.75, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "METROZOLE 125MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 19.5, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "diverticular-disease" } ] }