The following treatment for C. difficile colitis is considered appropriate:
1. Current antibiotics should be reviewed and any unnecessary
antibiotics should be discontinued.
2. Oral metronidazole is used as initial therapy of Clostridium difficile colitis. IV may be used if patient is NPO.
3. Initial C. difficile toxin assay must be ordered.
4. In cases where the patient has experienced prohibitive side effects or treatment failure with oral metronidazole, oral vancomycin may be used. I.V. vancomycin is not effective.
5. In cases treated with metronidazole where the patient
has not improved within 48-96 hours, some authorities recommend a switch to oral
vancomycin.
6. In severely immunosuppressed patients with severe
mucositis, some authorities use oral vancomycin as initial therapy.
Dose:
Metronidazole
Oral - 250 mg QID for 10 days
or
500 mg BID - TID for 10 - 14 days
IV - 250 - 500 mg every 6 hours.
Vancomycin
Oral - 125 mg every 6 hours for 7-10 days
250 mg every 6 hours for up to 14 days in critically ill patients.
Monitor:
1. Antibiotic discontinued if C. difficile toxin assay is negative.
