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For patients with a complete ileus, the recommendations include IV metronidazole and rectal vancomycin (500 mg in 100 mL of normal saline every 6 hours via rectal Foley tube). This stepwise treatment approach will be helpful for clinicians caring for patients with severe CDAD. Although studies are lacking, the consensus is that antimotility agents should not be used for CDAD, even if the CDAD is mild in severity.

Continuation of the inciting antibiotic may also contribute to treatment failures.