Vancomycin’s Benefits in C. difficile Declining

Metronidazole and vancomycin have been the mainstays of therapy for Clostridium difficile –associated disease (CDAD) for 25 years. Metronidazole often is chosen as the initial treatment because it costs less and using it reduces selection pressure for the emergence of vancomycin-resistant enterococci. Vancomycin, however, reaches much-higher concentrations in the stool than does metronidazole and often is considered the more effective agent; it is particularly useful as first-line therapy for patients with severe …