What is the initial treatment for a patient with mild to moderate C. difficile infection?

The initial treatment for a patient with mild to moderate Clostridioides difficile infection (CDI) is typically metronidazole at a dose of 500 mg taken three times a day for 14 days. This antibiotic works effectively against the specific bacteria causing the infection and is generally well-tolerated by patients with a mild to moderate presentation of CDI.

In managing mild to moderate CDI, the goal is to utilize an effective oral antibiotic that specifically targets the pathologic bacteria while minimizing risk factors and potential side effects associated with more aggressive treatments reserved for severe cases. Metronidazole is often preferred in such cases due to its demonstrated efficacy, cost-effectiveness, and favorable safety profile when compared to more intense therapies used in severe CDI situations.

Other options, such as vancomycin, are typically reserved for cases of severe CDI or for patients who have not responded to metronidazole, while intravenous fluid therapy primarily addresses dehydration rather than directly treating the infection. Oral probiotics may be considered for their supportive role in gut health but are not considered a primary treatment for CDI itself.