Rectum (12 of 30)

Therapy for PMC includes discontinuation of implicated antimicrobial agents, administration of antimicrobial agents directed against C. difficile, and supportive measures. Diarrhea will resolve without specific antimicrobial therapy in 15% to 25% of patients. Supportive measures include intravenous (IV) fluids to correct dehydration and electrolyte imbalance. Nutritional support may be required to correct hypoalbuminemia. Antiperistaltic agents should be avoided because they may delay clearance of toxins from the colon, leading to increased colonic injury, ileus, and toxic dilation. Antimicrobial options include oral metronidazole or vancomycin for 10 days. Antibiotic treatment should be oral, since C. difficile is restricted to the lumen of the colon. If IV treatment is necessary because the patient cannot tolerate oral medication or a feeding tube, only metronidazole is effective. Vancomycin should not be given intravenously because effective colonic luminal concentrations cannot be attained by this route.