A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity.

By F. Zar, Srinivasa R Bakkanagari, K. Moorthi, Melinda B Davis. Clinical Infectious Diseases, 2007

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Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. (2016, background): “Antibiotic use prior to first FMT 58 (13-645) 43.”
Metronidazole is still the drug of choice for treatment of anaerobic infections. (2010, background): “difficile infection, vancomycin therapy is recommended in North America but has yielded variable clinical responses [6].”
Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). (2018, positive): “Subsequently, other severity criteria [188] have been used to document improved clinical response rates for patients with severe CDI who received vancomycin as opposed to metronidazole [317].”
Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplant Recipients: A Global Perspective (2009, background): “Although both oral vancomycin and metronidazole promote overgrowth of VRE in stool, the risk of acquiring VRE or promoting VRE overgrowth should not be a defining consideration when selecting oral vancomycin for treatment of severe or recurrent C. difficile infection (BIII) [650, 651] .”