Less is more The physician will treat a mild case of antibiotic-related CDAD by simply discontinuing the antibiotic. Besides that, a patient may need only fluid and electrolyte replacement. If the physician can't discontinue the antibiotic because of the patient's condition, he'll likely prescribe an alternative antimicrobial that's less likely to imbalance the bowel flora. He'll also discontinue any antidiarrheals. If CDAD isn't related to antibiotic administration, the physician will simply monitor the patient.
Current practice is to start with metronidazole, then use vancomycin if treatment fails.
That's because metronidazole is cheaper and won't contribute to vancomycin resistance in other fecal organisms, such as enterococci. In any case, treatment should continue for 10 to 14 days. At the same time, he may also use cholestyramine as an adjunct to treatment because this anion exchange resin binds C. difficile toxins. One risk factor for VRE is past antimicrobial therapy with vancomycin, third-generation cephalosporins, or other antibiotics targeted at anaerobic bacteria such as C. difficile. Although the mechanisms and pathophysiology of disease for VRE and C. difficile differ, using contact precautions for one will help limit the spread of the other.