What are effective therapies for Clostridium difficile- associated diarrhea?
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Oral metronidazole and oral vancomycin are equally effective treatments for Clostridium difficile- associated diarrhea (CDAD) (strength of recommendation [SOR]: A, based on randomized trials). Oral vancomycin is considerably more expensive and may select for colonization with vancomycin-resistant enterococci, leading the American College of Gastroenterology to recommend oral metronidazole as preferred therapy (SOR: C, expert opinion). They recommend therapy with vancomycin for those who are pregnant, breast feeding, less than 10years old, nonresponders to metronidazole, critically ill, or allergic or intolerant to metronidazole (SOR: C, expert opinion).
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