Which medications in the drug class Glycopeptides are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Oral vancomycin does not get absorbed and acts directly at the site of infection.

Vancomycin (Firvanq, Vancocin)

Vancomycin has excellent in vitro activity against C difficile. This agent kills the organism by inhibiting cell wall synthesis. Significant luminal levels after administration of PO vancomycin can be obtained because the drug is poorly absorbed from the GI tract. Its major disadvantage, however, is that it is relatively expensive.

Because of the cost and the concern over the emergence of vancomycin-resistant enterococci strains, this agent should be reserved for patients who cannot tolerate or do not respond to metronidazole, pregnant patients, and patients younger than 10 years.

Vancomycin is also preferred for severe cases and in patients who are high risk. Unlike IV metronidazole, IV vancomycin is not excreted into the GI lumen; therefore, it is difficult to deliver effective IV doses. Available orally as capsules or oral solution.

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