Which medications in the drug class Antibiotics, Other 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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Antibiotics, Other

The purpose of treatment is to eradicate C difficile infection (CDI) and/or promote restoration of the normal colonic flora.

Metronidazole (Flagyl)

Metronidazole is recommended as the treatment of choice for mild to moderate cases of CDI. This agent provides effective therapy, with reported response rates from 95-100%. Its in vitro activity is bactericidal and dose dependent. Standard dosing has been shown to promote fecal concentrations capable of a 99.99% reduction of C difficile.

Metronidazole is relatively inexpensive. Intravenous (IV) metronidazole may be administered to those patients who cannot tolerate oral (PO) medications because of its potential to accumulate in the inflamed colon. However, the IV route is not as effective as the PO route.


Bacitracin inhibits the formation of major components of the bacterial cell wall and is bactericidal. This agent is used as an alternative therapy for CDI, but it is expensive and not as effective as metronidazole or vancomycin in clinical trials and is thus without sufficient data to warrant its use. Bacitracin is bitter and must be specially prepared in capsule form to prevent nausea. This agent is administered PO, and it is only negligibly absorbed from the gastrointestinal (GI) tract.

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