title: Treatment of metronidazole-refractory Clostridium difficile enteritis with vancomycin.
abstract: BACKGROUND
  Clostridium difficile infection of the colon is a common and well-described clinical entity. Clostridium difficile enteritis of the small bowel is believed to be less common and has been described sparsely in the literature.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  We describe a patient who had undergone total proctocolectomy with ileal pouch-anal anastomosis who was treated with broad-spectrum antibiotics and contracted C. difficile refractory to metronidazole. The enteritis resolved quickly after initiation of combined oral vancomycin and metronidazole. A literature review found that eight of the fifteen previously reported cases of C. difficile-associated small-bowel enteritis resulted in death.
  
  
  CONCLUSIONS
  It is important for physicians who treat acolonic patients to be aware of C. difficile enteritis of the small bowel so that it can be suspected, diagnosed, and treated.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Follmar
authors.forename: Sara A
authors.initials: SA
authors.lastname: Condron
authors.forename: Immanuel I
authors.initials: II
authors.lastname: Turner
authors.forename: Jaimie D
authors.initials: JD
authors.lastname: Nathan
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Ludwig
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D018432:Drug Resistance, Multiple; D004751:Enteritis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D017211:Treatment Failure; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin