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Patients with mild to moderate diarrhea or colitis, as defined by the absence of leukocytosis, acute kidney injury, fever, sepsis, or megacolon, should receive antibiotic therapy with oral metronidazole or oral vancomycin (in those who are intolerant to metronidazole) for 10-14 days. The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) indicate that metronidazole (500 mg PO TID for 10-14 days) is the drug of choice in these patients. [5]

In a retrospective study of 300 patients, a low-dose regimen of oral vancomycin (< 500 mg/day) was as effective as a high-dose regimen (>500 mg/day) for the treatment of CDIs. Clinical improvement rates for the low- and high-dose regimens were 85% and 86%, respectively, at 72 hours and 93% and 96%, respectively, at the end of therapy/hospital discharge. Patients on the low vancomycin dose had lower in-hospital mortality rates (15% versus 23%) but higher C difficile –related hospital readmission rates (12% vs 5%).
Probiotics are generally not recommended for the treatment of active CDI owing to limited data supporting their benefits and a potential risk for septicemia. [5] However, a meta-analysis that evaluated 34 studies and 4138 patients supported earlier studies indicating that probiotics can prevent the diarrhea that is associated with antibiotic use.
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