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If unable to take metronidazole, vancomycin 125 mg orally four times a day for 10 days. A meta-analysis of 12 observational studies and randomized control trials (RCTs) showed that continued use of antimicrobials for infections other than CDI is significantly associated with an increased risk of CDI recurrence (47). In light of this consistent observational evidence, exposure to antibiotics other than those intended to treat CDI should be avoided unless absolutely indicated.
The two first-line antibiotics used most often to treat CDI in North America are metronidazole and vancomycin; a third, fidaxomicin, was approved for treatment of CDI in 2011.
Treatment for CDI can be initiated before laboratory confirmation for patients with a high pre-test suspicion of disease.