Vancomycin is effective against many gram positive bacteria and is often used in cases of C. diff associated diarrhea. It must be given orally and not intravenously, because the intravenous form doesn’t get excreted into the colon in appreciable enough amounts to kill the bacteria. If oral vancomycin is not used for the first episode of C. diff, it is often effective in treating refractory disease as well.
Fidaxomicin is bactericidal against C. difficile and is another option for treatment of both initial and refractory disease. It is more expensive than other antibiotics, however.
Metronidazole is an antibiotic with activity against anaerobic bacteria and is another option for the treatment of C. difficile colitis. It can be given either orally or intravenously, with intravenous being preferred for severe disease. Metronidazole has been associated with more episodes of treatment failure than vancomycin or fidaxomicin, but it is still used regularly around the world.
Stool transplant, also known as fecal microbiota transplantation or bacteriotherapy, is highly effective for patients with refractory disease that has failed antibiotic therapy. This procedure involves infusion of fecal bacteria from a donor to the patient, restoring normal colonic flora.
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