Intravenous vancomycin is not effective in the treatment of CDIC because significant levels in the intestine have not been demonstrated with parenteral administration. Recently, the Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control issued recommendations that vancomycin only be used to treat CDIC which fails to respond to metronidazole or if CDIC is severe and potentially life threatening. These recommendations were aimed at reducing the spread of vancomycin resistance. Mild relapses do not necessarily require the use of metronidazole or vancomycin because many may resolve spontaneously. Conservative treatment may decrease the potential for subsequent relapses.
More severe relapses respond well to retreatment with metronidazole or vancomycin.
It is not necessary to use vancomycin to treat relapses following metronidazole therapy or vice versa since relapse is not usually secondary to the development of resistance. Unfortunately, some of these patients suffer from multiple relapses, and there is no specific treatment except intermittent or prolonged therapy with vancomycin or metronidazole. Suggestions for the management of repeated relapses include the introduction of competing, nonpathogenic organisms into the intestinal tract either by enema or orally, slow-tapering of vancomycin therapy, use of rifampin with vancomycin, use of cholestyramine with vancomycin, use of bacitracin, treatment with yeast Saccharomyces boulardii , or oral administration of nontoxicogenic C. difficile . Oral or intravenous immunoglobulins have been used to treat chronic relapsing CDIC in children. All Rights Reserved.