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Internal Medicine


Answer 4
  1. Intravenous vancomycin. Generally, the drug of choice for uncomplicated C. difficile colitis is 500 mg oral metronidazole 4 times daily for 10 days. Relapse may be treated with a repeat course of metronidazole. Patients with recalcitrant colitis or intolerance to metronidazole may be treated with 125 mg oral vancomycin 4 times daily for 10 days; this regimen is much more expensive and should not be first-line treatment in most patients. A several week taper of oral vancomycin is occasionally utilized in patients with numerous recurrences. Intravenous metronidazole may be useful in patients with significant ileus, in whom vomiting, bowel edema, and nasogastric suction may preclude the oral route of administration. Metronidazole is secreted into the bowel mucosa from the bloodstream when administered intravenously, unlike vancomycin, which is only effective when given enterally.

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