The IDSA and SHEA guidelines recommend the use of either vancomycin or fidaxomicin over metronidazole for an initial episode of CDI. The dosage is vancomycin 125 mg orally four times per day or fidaxomicin 200 mg twice daily for 10 days.
In settings where access to vancomycin or fidaxomicin is limited, metronidazole is suggested for an initial episode of nonsevere CDI only. The suggested dosage is metronidazole 500 mg orally three times per day for 10 days. Avoid repeated or prolonged courses due to the risk of cumulative and potentially irreversible neurotoxicity.
Discontinue therapy with the inciting antibiotic agent(s) as soon as possible because this may influence the risk of CDI recurrence.
Antibiotic therapy for CDI should be started empirically for situations in which a substantial delay in laboratory confirmation is expected or in patients with fulminant colitis.
Learn more about the guidelines on CDI.
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Cite this: B.S. Anand. Fast Five Quiz: Antibiotic-Associated Diarrhea - Medscape - Jul 09, 2020.