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Rectal administration appears to be a potentially useful adjunct in patients with ileus, though therapy by this method alone should not be expected to exert much effect proximal to the splenic flexure. Shetler and associates described a case series in which 4 of 7 patients with severe C.

In these patients, the guidelines recommend initial therapy with vancomycin 125 mg four times daily. Complicated CDAD is defined as the presence of one or more of the following factors: hypotension, ileus, toxic megacolon, need for ICU admission or colectomy, or colonic perforation.

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).