Clostridium difficile Infection and Inflammatory Bowel Disease: A Review

Table 2

Treatment of Clostridium difficile infection: IDSA guidelines: [66].

Disease category	Treatment
Initial episode, mild to moderate disease	Metronidazole 500 mg three times a day by mouth for 10–14 days
Initial episode, severe disease (uncomplicated)*	Vancomycin 125 mg four times a day by mouth for 10–14 days
Initial episode, severe infection (complicated)*	Vancomycin, 500 mg four times a day by mouth or by nasogastric tube, plus metronidazole, 500 mg every 8 hours intravenously. If complete Ileus, consider rectal instillation of vancomycin
For recurrence	Same as for initial episode
Second recurrence	Vancomycin in a tapered and/or pulsed regime

* Severe uncomplicated infection: white blood cell count of 15,000 cells/μL or higher or serum creatinine level greater than or equal to 1.5 times the premorbid level. Severe complicated infection: hypotension or shock, ileus, megacolon (classification based on expert opinion by Infectious disease society of America (IDSA) [66].