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In the VA study by Musher and colleagues, 30 of the 46 patients who still had symptoms after 10 days of metronidazole therapy were treated with a prolonged course. Symptom resolution was achieved in only half of these patients with metronidazole alone. 10 Of course, in such patients the need for colectomy versus a longer course of medical therapy must be seriously considered, but as long as the patients continue to improve, even if slowly, the latter may be reasonable.
In such ill patients, adjunct therapies such as intravenous (IV) metronidazole may be helpful.