# Clostridioides difficile Colitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) - Verified date: 2026-08 ## Verified against - IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update - Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) - Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt) - Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-full.txt) ## Treatment metadata - Vancomycin — 125 mg — oral.solid - Referral & safety-netting (no drug therapy) - Metronidazole — 500 mg — oral.solid - Rifaximin — oral.solid ## Complete treatment card ```text CLOSTRIDIOIDES DIFFICILE COLITIS Sources: IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) Review status: REVIEWED against IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update, Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph), Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt), Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Presentation spans asymptomatic carriage through mild diarrhea to severe fever, colitis, and septic shock [diarrhoea · fever · shock] - Progression to fulminant colitis brings diffuse abdominal pain, distension, hypovolemia, and risk of bowel perforation with peritonitis [abdominal pain] - Extra-colonic manifestations can include appendicitis-like symptoms and reactive arthritis, plus protein-losing enteropathy - Recurrent disease means symptoms fully resolve with treatment, then relapse [relapse] TESTS (6) - Diarrhea persisting more than 48 hours after admission, or a community-acquired presentation with no typical exposures, also warrants testing - No single assay is reliable alone, so a 2-step sequential testing strategy is required - A negative GDH antigen or NAAT screen generally ends the workup, but a positive result alone does not confirm toxin production - A positive antigen or NAAT screen still needs an EIA for toxins A and B to confirm active toxin production - PCR-based testing, alone or as part of a multistep approach, gives the highest sensitivity and specificity - Abdominal/pelvic imaging or lower GI endoscopy may be added for fulminant colitis or when other diagnoses are being weighed IF NOT THIS - what else fits (3) - Inflammatory bowel disease mimics: Crohn disease and ulcerative colitis - Other infectious diarrhea: Salmonella, shigellosis, vibrio infections, and viral gastroenteritis - Structural or functional mimics: diverticulitis, irritable bowel syndrome, malabsorption, and peritonitis Source StatPearls "Clostridioides difficile infection" - disease-level clinical article Status traced to the source above 1. VANCOMYCIN [1st line] Adult 125 mg ORALLY 4 times daily x 10 days Peds 10 mg/kg/dose [child max 125 mg] (10 mg/kg orally 4 times daily (max 125 mg per dose) for 10 days) 3kg -> 30 mg/dose 4kg -> 40 mg/dose 5kg -> 50 mg/dose 6kg -> 60 mg/dose 7kg -> 70 mg/dose 8kg -> 80 mg/dose 9kg -> 90 mg/dose 10kg -> 100 mg/dose 11kg -> 110 mg/dose 12kg -> 120 mg/dose 13kg -> 125 mg/dose (capped) 14kg -> 125 mg/dose (capped) 15kg -> 125 mg/dose (capped) 16kg -> 125 mg/dose (capped) 17kg -> 125 mg/dose (capped) 18kg -> 125 mg/dose (capped) 19kg -> 125 mg/dose (capped) 20kg -> 125 mg/dose (capped) 21kg -> 125 mg/dose (capped) 22kg -> 125 mg/dose (capped) 23kg -> 125 mg/dose (capped) 24kg -> 125 mg/dose (capped) 25kg -> 125 mg/dose (capped) 26kg -> 125 mg/dose (capped) 27kg -> 125 mg/dose (capped) 28kg -> 125 mg/dose (capped) 29kg -> 125 mg/dose (capped) 30kg -> 125 mg/dose (capped) 31kg -> 125 mg/dose (capped) 32kg -> 125 mg/dose (capped) 33kg -> 125 mg/dose (capped) 34kg -> 125 mg/dose (capped) 35kg -> 125 mg/dose (capped) 36kg -> 125 mg/dose (capped) 37kg -> 125 mg/dose (capped) 38kg -> 125 mg/dose (capped) 39kg -> 125 mg/dose (capped) 40kg -> 125 mg/dose (capped) 41kg -> 125 mg/dose (capped) 42kg -> 125 mg/dose (capped) 43kg -> 125 mg/dose (capped) 44kg -> 125 mg/dose (capped) 45kg -> 125 mg/dose (capped) 46kg -> 125 mg/dose (capped) 47kg -> 125 mg/dose (capped) 48kg -> 125 mg/dose (capped) 49kg -> 125 mg/dose (capped) 50kg -> 125 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update Why First-line oral treatment available in Egyptian hospitals and pharmacies; fidaxomicin is expensive and poorly available Caution MUST BE GIVEN ORALLY: IV vancomycin is NOT excreted into the intestinal lumen and is completely ineffective for C. difficile. Discontinue offending prior antibiotic if possible. Monitor for recurrence (20% of cases). Egypt KEMPOVANCOM 500 MG VIAL KAHIRA > MODE... 18.00 EGP -> ? strength differs, ? different route - not oral solid VANCOZIN 500 MG VIAL EIMC > KOREA ... 38.00 EGP -> ? strength differs, ? different route - not oral solid VANCOMIX 500MG I.V. VIAL SIGMA TEC 79.00 EGP -> ? strength differs, ? different route - not oral solid VANCOLON 500MG I.V. VIAL JULPHAR 95.50 EGP -> ? strength differs, ? different route - not oral solid VANCOMYCINE VIATRIS 500 MG VIAL VIANAX - GREE... 142.00 EGP -> ? strength differs, ? different route - not oral solid VETOVANCIN 1 GM I.V. VIAL SIGMA TEC > V... 176.00 EGP -> ? strength differs, ? different route - not oral solid VANCOMYCINE VIATRIS 1 GM VIAL VIANAX - GREE... 204.00 EGP -> ? strength differs, ? different route - not oral solid VANCOMYCIN-LYOMARK 1000MG VIAL FOR ORAL OR INF. USE LYOMARK-PHARMA > PHA... 226.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Clostridioides difficile infection - disease-level clinical article (c-difficile- infection-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The laboratory criteria defining severe infection are WBC, albumin, and creatinine. RED FLAG - Ileus means oral vancomycin does not reach the colon adequately and IV metronidazole may be needed instead. RED FLAG - Fulminant colitis may require surgical intervention (subtotal colectomy). RED FLAG - An initial fulminant/severe episode (hypotension, shock, ileus, megacolon) needs much higher-dose vancomycin (500 mg) than the standard 125 mg dose. RED FLAG - Adjunctive IV metronidazole is recommended alongside vancomycin for an initial fulminant/severe episode. 3. METRONIDAZOLE [2nd line] Adult 500 mg orally 3 times daily x 10-14 days Peds 7.5 mg/kg/dose [child max 500 mg] (7.5 mg/kg orally 3 times daily for 10 days) 3kg -> 22.5 mg/dose 4kg -> 30 mg/dose 5kg -> 37.5 mg/dose 6kg -> 45 mg/dose 7kg -> 52.5 mg/dose 8kg -> 60 mg/dose 9kg -> 67.5 mg/dose 10kg -> 75 mg/dose 11kg -> 82.5 mg/dose 12kg -> 90 mg/dose 13kg -> 97.5 mg/dose 14kg -> 105 mg/dose 15kg -> 112.5 mg/dose 16kg -> 120 mg/dose 17kg -> 127.5 mg/dose 18kg -> 135 mg/dose 19kg -> 142.5 mg/dose 20kg -> 150 mg/dose 21kg -> 157.5 mg/dose 22kg -> 165 mg/dose 23kg -> 172.5 mg/dose 24kg -> 180 mg/dose 25kg -> 187.5 mg/dose 26kg -> 195 mg/dose 27kg -> 202.5 mg/dose 28kg -> 210 mg/dose 29kg -> 217.5 mg/dose 30kg -> 225 mg/dose 31kg -> 232.5 mg/dose 32kg -> 240 mg/dose 33kg -> 247.5 mg/dose 34kg -> 255 mg/dose 35kg -> 262.5 mg/dose 36kg -> 270 mg/dose 37kg -> 277.5 mg/dose 38kg -> 285 mg/dose 39kg -> 292.5 mg/dose 40kg -> 300 mg/dose 41kg -> 307.5 mg/dose 42kg -> 315 mg/dose 43kg -> 322.5 mg/dose 44kg -> 330 mg/dose 45kg -> 337.5 mg/dose 46kg -> 345 mg/dose 47kg -> 352.5 mg/dose 48kg -> 360 mg/dose 49kg -> 367.5 mg/dose 50kg -> 375 mg/dose Source Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) Why Second-line option for initial non-severe C. difficile episode when oral vancomycin is unavailable Caution Less effective than oral vancomycin; avoid in recurrent or severe colitis. Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid 4. RIFAXIMIN [3rd line] Adult 400 mg orally 3 times daily x 20 days Peds No paediatric dose is stated in the sources held for this drug. Source Clostridioides difficile Colitis - disease-level clinical article (c-difficile- infection-clinical.txt) Why Follow-on oral antibiotic regimen for second or subsequent recurrence of Clostridioides difficile infection. Caution Added to the lactulose, not instead of it. The licensed indication is preventing recurrence on top of lactulose, and stopping the lactulose loses most of the benefit. This is prevention after an episode has happened, not treatment of the acute confusion in front of you - that is still lactulose titrated to 2-3 soft stools a day. The 550 mg strength is the encephalopathy strength. The 200 mg tablets are the travellers' diarrhoea product and three of them a day is not the same prescription. Barely absorbed, so systemic side effects are few, but peripheral oedema and dizziness are reported in over 10%. Egypt IDIBACT 200 MG 10 F.C.TAB. INTERNATIONAL... 34.00 EGP (3.40/unit) TRENCEDIA 200 MG 30 F.C. TABS. MARCYRL PHARM... 130.50 EGP (4.35/unit) IDIBACT 550 MG 20 F.C.TAB. INTERNATIONAL... 103.75 EGP (5.19/unit) FATROXIM 200 MG 10 F.C. TAB. EGPI > ATM PH... 81.00 EGP (8.10/unit) DUFAXIMIN 200 MG 28 F.C. TABS. AUG PHARMA 232.00 EGP (8.29/unit) BIOREFAMIN 550 MG 10 F.C.TABS. P & C LABS > ... 148.00 EGP (14.80/unit) GASTROBIOTIC 550 MG 30 F.C. TAB. ANDALOUS PHARMA 516.00 EGP (17.20/unit) TRAVIGUARD 550 MG 20 F.C. TABS. P AND C LABS ... 344.00 EGP (17.20/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)