IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection.
Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old.
But with the caveat that I’m not an expert in this area, these particular treatment recommendations continue to perplex me:
Metronidazole is the drug of choice for the initial episode of mild‐to‐moderate Clostridium difficile infection (CDI). The dosage is 500 mg orally 3 times per day for 10–14 days.
Vancomycin is the drug of choice for an initial episode of severe CDI. The dosage is 125 mg orally 4 times per day for 10–14 days.
In what other diseases do we recommend something different for mild vs. severe infection, when both are oral options? I understand there is a cost difference, but since the data on treatment of severe CDI demonstrate the superiority of vancomycin, is this the right approach? Especially since oral vancomycin is better tolerated?
Or are we still going through this widely-quoted (and frankly kind of politically incorrect!) mom vs mother-in-law dilemma?
With the intention of being provocative, what would you take if you had C diff?