Currently, there are two mainstream medical choices (however, due to both antibiotic resistance and tactics employed by bacteria for self-protection, these antibiotics may NOT be successful ):
• Metronidazole (Flagyl) - usually first choice (several hundred $$$ cheaper and antibiotic resistance less of a concern); destroys functioning enzymes of C. difficile .
• Vancomycin (Vancocin HCl) - a bacteriostatic/doesn't kill bacteria; prevents C. difficile from reproducing.
- The standard dose schedule is 4 times a day for 10-14 days. Response to therapy can be assessed by the resolution of fever, usually within the first two days. Diarrhea should improve within 2-4 days and resolve within 2 weeks. .
- These antibiotics deal with the active (vegetative) form of C. difficile, but do not kill its spores - which can germinate and possibly "hide" in intestinal folds;
Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol 1997;92(5):739-50
- Pulse dose antibiotic therapy - involves alternating antibiotic treatment with no medication, each for several days at a time. The theory is that by stopping and starting the antibiotic, the C. difficile spores hatch, and are then killed by the next pulse of antibiotics.
- Tapering off vancomycin or metronidazoleover 4-6 weeks may be more effective than stopping abruptly - the theory beingthat this allows for restoration of normal gut flora whilst antibiotic continues to kill C. Difficile .
Tedesco FJ, Gordon D, Forston WC. Approach to patients with multiple relapses of antibiotic-associated pseudomembranous colitis. Am J Gastroenterol 1985;80(11):867-8
For customary antibiotic dosage against C. difficile:
Antibiotic / Probiotic Therapy Dosages againstC. Difficile Infection
