Vancomycin (125 to 500 mg given three or four times daily) is an effective treatment for C. difficile colitis. It is neither absorbed from nor metabolized within the GI tract and is excreted virtually unchanged. A lower dose (125 mg three times daily) is recommended for moderate to severe forms of C. difficile infection, whereas higher doses (up to 500 mg given four times daily) may be preferable for severe, life threatening C. difficile infection. In patients that are unable to tolerate oral treatment, vancomycin can be given in enema formulation (500 mg in 100 mL of normal saline administered every 6 hours) as well as via a nasogastric tube. Unlike metronidazole, vancomycin is ineffective when given intravenously because it does not reach the colonic lumen.

Although the efficacy of oral vancomycin in treating C. difficile colitis is excellent and side effects are rare, it should be reserved as a second line agent for two reasons. Firstly, the cost of oral vancomycin is considerably greater than metron-idazole. A 10 day course of orally formulated vancomycin may cost as much as $800, whereas a 10 day course of oral metronidazole may cost as little as $20. Secondly, the risk of promoting vancomycin resistance amongst nosocomial bacteria makes metronidazole the favored first line agent. Vancomycin is reserved for patients who are intolerant to metronidazole, fail to respond to metronidazole, are pregnant, or are under the age of 10 years.

Other treatments for C. difficile infections that have been published include the use of bacitracin, teicoplanin, fusidic acid, and colestipol (Kyne et al, 2001). Bacitracin (25,000 U given four times a day for 7 to 10 days) is less effective than metronidazole and vancomycin. Teicoplanin, although associated with a slightly lower relapse rate (7%), is not currently available for oral administration in the United States. Fusidic acid and colestipol are associated with lower response rates as compared to metronidazole and vancomycin, and they are not recommended as primary treatments.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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