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Furthermore, it remains vital that trials of aggressive and maximal medical therapy do not forestall surgical evaluation. Summary Appropriate measures for a clinically deteriorating patient include the addition of vancomycin to metronidazole, surgical evaluation, and consideration of IV metronidazole and intracolonic vancomycin, particularly in cases complicated by ileus.
Once again, assessing whether the causative antibiotic can be discontinued is of critical importance. With severe disease, initial therapy is recommended with vancomycin 125 mg orally every 6 hours.