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Moreover, there are data to suggest that IV metronidazole will also enter the colon lumen following secretion across the inflamed colonic mucosa, and CDI patients who respond to treatment have a dramatic fall in the fecal concentrations of the antibiotic following initiation of therapy.
The duration of enema therapy should continue until the patient has significant improvement. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence). A literature review of 55 patients with CDI who were exposed to such agents found that 17 patients developed colonic dilatation and 5 died (59).