What is the recommended medication treatment for severe cases of Clostridium difficile (C diff) colitis?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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As noted above, for severe cases, vancomycin (125 mg PO QID for 10 days) is the recommended first-line therapy. Higher dosing (250 mg PO [or per nasogastric tube] QID) may be used in situations such as ileus. Excretion of the drug into bile and exudation from the inflamed colon results in bactericidal levels in feces. Intravenous vancomycin is ineffective and should not be used for C difficile. The SHEA and IDSA recommend metronidazole (500 mg IV q8h) with vancomycin (500 mg PO QID and/or 500 mg PR q6h in 100 mL normal saline as a retention enema) for severe or complicated cases of CDI. [5]

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