Dawaa Reference

infectious

Clostridioides difficile Colitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)

Verified against4 documents
  • IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update
  • Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)
  • Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt)
  • Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Presentation spans asymptomatic carriage through mild diarrhea to severe fever, colitis, and septic shock [diarrhoea · fever · shock]
  • Progression to fulminant colitis brings diffuse abdominal pain, distension, hypovolemia, and risk of bowel perforation with peritonitis [abdominal pain]
  • Extra-colonic manifestations can include appendicitis-like symptoms and reactive arthritis, plus protein-losing enteropathy
  • Recurrent disease means symptoms fully resolve with treatment, then relapse [relapse]

Tests (6)

  • Diarrhea persisting more than 48 hours after admission, or a community-acquired presentation with no typical exposures, also warrants testing
  • No single assay is reliable alone, so a 2-step sequential testing strategy is required
  • A negative GDH antigen or NAAT screen generally ends the workup, but a positive result alone does not confirm toxin production
  • A positive antigen or NAAT screen still needs an EIA for toxins A and B to confirm active toxin production
  • PCR-based testing, alone or as part of a multistep approach, gives the highest sensitivity and specificity
  • Abdominal/pelvic imaging or lower GI endoscopy may be added for fulminant colitis or when other diagnoses are being weighed

If not this — what else fits (3)

  • Inflammatory bowel disease mimics: Crohn disease and ulcerative colitis
  • Other infectious diarrhea: Salmonella, shigellosis, vibrio infections, and viral gastroenteritis
  • Structural or functional mimics: diverticulitis, irritable bowel syndrome, malabsorption, and peritonitis

SourceStatPearls "Clostridioides difficile infection" - disease-level clinical article

Presentation findings are traced to the source above.

1

VANCOMYCIN

1st line

Strength125 mg

Formoral.solid

Adult dose and duration

125 mg ORALLY 4 times daily x 10 days

Paediatric dose

10 mg/kg/dose [child max 125 mg]

(10 mg/kg orally 4 times daily (max 125 mg per dose) for 10 days)

Dose by weight
3kg30 mg/dose
4kg40 mg/dose
5kg50 mg/dose
6kg60 mg/dose
7kg70 mg/dose
8kg80 mg/dose
9kg90 mg/dose
10kg100 mg/dose
11kg110 mg/dose
12kg120 mg/dose
13kg125 mg/dose (capped)
14kg125 mg/dose (capped)
15kg125 mg/dose (capped)
16kg125 mg/dose (capped)
17kg125 mg/dose (capped)
18kg125 mg/dose (capped)
19kg125 mg/dose (capped)
20kg125 mg/dose (capped)
21kg125 mg/dose (capped)
22kg125 mg/dose (capped)
23kg125 mg/dose (capped)
24kg125 mg/dose (capped)
25kg125 mg/dose (capped)
26kg125 mg/dose (capped)
27kg125 mg/dose (capped)
28kg125 mg/dose (capped)
29kg125 mg/dose (capped)
30kg125 mg/dose (capped)
31kg125 mg/dose (capped)
32kg125 mg/dose (capped)
33kg125 mg/dose (capped)
34kg125 mg/dose (capped)
35kg125 mg/dose (capped)
36kg125 mg/dose (capped)
37kg125 mg/dose (capped)
38kg125 mg/dose (capped)
39kg125 mg/dose (capped)
40kg125 mg/dose (capped)
41kg125 mg/dose (capped)
42kg125 mg/dose (capped)
43kg125 mg/dose (capped)
44kg125 mg/dose (capped)
45kg125 mg/dose (capped)
46kg125 mg/dose (capped)
47kg125 mg/dose (capped)
48kg125 mg/dose (capped)
49kg125 mg/dose (capped)
50kg125 mg/dose (capped)
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

IDSA/SHEA Clinical Practice Guideline on C. difficile 2021 Update

Why

First-line oral treatment available in Egyptian hospitals and pharmacies; fidaxomicin is expensive and poorly available

Cautions
  • MUST BE GIVEN ORALLY: IV vancomycin is NOT excreted into the intestinal lumen and is completely ineffective for C. difficile.
  • Discontinue offending prior antibiotic if possible.
  • Monitor for recurrence (20% of cases).
Egyptian brands
Egyptian brandManufacturerIndicative price
KEMPOVANCOM 500 MG VIAL? strength differs? different route - not oral solidKAHIRA > MODERN OFFICE FOR IMPORT18.00 EGP
VANCOZIN 500 MG VIAL? strength differs? different route - not oral solidEIMC > KOREA UNITED PHARMA38.00 EGP
VANCOMIX 500MG I.V. VIAL? strength differs? different route - not oral solidSIGMA TEC79.00 EGP
VANCOLON 500MG I.V. VIAL? strength differs? different route - not oral solidJULPHAR95.50 EGP
VANCOMYCINE VIATRIS 500 MG VIAL? strength differs? different route - not oral solidVIANAX - GREECE > ONE PHARMA MEDICS142.00 EGP
VETOVANCIN 1 GM I.V. VIAL? strength differs? different route - not oral solidSIGMA TEC > VETOPHARM-EGYPT176.00 EGP
VANCOMYCINE VIATRIS 1 GM VIAL? strength differs? different route - not oral solidVIANAX - GREECE > ONE PHARMA MEDICS204.00 EGP
VANCOMYCIN-LYOMARK 1000MG VIAL FOR ORAL OR INF. USE? strength differs? different route - not oral solidLYOMARK-PHARMA > PHARMACON226.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Clostridioides difficile infection - disease-level clinical article (c-difficile-infection-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The laboratory criteria defining severe infection are WBC, albumin, and creatinine.
  • RED FLAG - Ileus means oral vancomycin does not reach the colon adequately and IV metronidazole may be needed instead.
  • RED FLAG - Fulminant colitis may require surgical intervention (subtotal colectomy).
  • RED FLAG - An initial fulminant/severe episode (hypotension, shock, ileus, megacolon) needs much higher-dose vancomycin (500 mg) than the standard 125 mg dose.
  • RED FLAG - Adjunctive IV metronidazole is recommended alongside vancomycin for an initial fulminant/severe episode.
3

METRONIDAZOLE

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg orally 3 times daily x 10-14 days

Paediatric dose

7.5 mg/kg/dose [child max 500 mg]

(7.5 mg/kg orally 3 times daily for 10 days)

Dose by weight
3kg22.5 mg/dose
4kg30 mg/dose
5kg37.5 mg/dose
6kg45 mg/dose
7kg52.5 mg/dose
8kg60 mg/dose
9kg67.5 mg/dose
10kg75 mg/dose
11kg82.5 mg/dose
12kg90 mg/dose
13kg97.5 mg/dose
14kg105 mg/dose
15kg112.5 mg/dose
16kg120 mg/dose
17kg127.5 mg/dose
18kg135 mg/dose
19kg142.5 mg/dose
20kg150 mg/dose
21kg157.5 mg/dose
22kg165 mg/dose
23kg172.5 mg/dose
24kg180 mg/dose
25kg187.5 mg/dose
26kg195 mg/dose
27kg202.5 mg/dose
28kg210 mg/dose
29kg217.5 mg/dose
30kg225 mg/dose
31kg232.5 mg/dose
32kg240 mg/dose
33kg247.5 mg/dose
34kg255 mg/dose
35kg262.5 mg/dose
36kg270 mg/dose
37kg277.5 mg/dose
38kg285 mg/dose
39kg292.5 mg/dose
40kg300 mg/dose
41kg307.5 mg/dose
42kg315 mg/dose
43kg322.5 mg/dose
44kg330 mg/dose
45kg337.5 mg/dose
46kg345 mg/dose
47kg352.5 mg/dose
48kg360 mg/dose
49kg367.5 mg/dose
50kg375 mg/dose
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)

Why

Second-line option for initial non-severe C. difficile episode when oral vancomycin is unavailable

Cautions
  • Less effective than oral vancomycin; avoid in recurrent or severe colitis.
  • Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP
4

RIFAXIMIN

3rd line

Formoral.solid

Adult dose and duration

400 mg orally 3 times daily x 20 days

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Clostridioides difficile Colitis - disease-level clinical article (c-difficile-infection-clinical.txt)

Why

Follow-on oral antibiotic regimen for second or subsequent recurrence of Clostridioides difficile infection.

Cautions
  • Added to the lactulose, not instead of it. The licensed indication is preventing recurrence on top of lactulose, and stopping the lactulose loses most of the benefit.
  • This is prevention after an episode has happened, not treatment of the acute confusion in front of you - that is still lactulose titrated to 2-3 soft stools a day.
  • The 550 mg strength is the encephalopathy strength. The 200 mg tablets are the travellers' diarrhoea product and three of them a day is not the same prescription.
  • Barely absorbed, so systemic side effects are few, but peripheral oedema and dizziness are reported in over 10%.
Egyptian brands
Egyptian brandManufacturerIndicative price
IDIBACT 200 MG 10 F.C.TAB.INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA34.00 EGP (3.40/unit)
TRENCEDIA 200 MG 30 F.C. TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)130.50 EGP (4.35/unit)
IDIBACT 550 MG 20 F.C.TAB.INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA103.75 EGP (5.19/unit)
FATROXIM 200 MG 10 F.C. TAB.EGPI > ATM PHARMACEUTICAL INDUSTRIES81.00 EGP (8.10/unit)
DUFAXIMIN 200 MG 28 F.C. TABS.AUG PHARMA232.00 EGP (8.29/unit)
BIOREFAMIN 550 MG 10 F.C.TABS.P & C LABS > SOVALUE PHARMA148.00 EGP (14.80/unit)
GASTROBIOTIC 550 MG 30 F.C. TAB.ANDALOUS PHARMA516.00 EGP (17.20/unit)
TRAVIGUARD 550 MG 20 F.C. TABS.P AND C LABS > TREND PHARM344.00 EGP (17.20/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.