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Moderate"Fulminant C. difficile warrants high-dose oral vancomycin (500 mg PO QID) plus IV metronidazole; consider rectal vancomycin if ileus. Lower-dose or metronidazole alone is inadequate (AFulminant C. difficilenot monotherapy (e)."

A 59-year-old man presents with watery diarrhea and abdominal pain after high-risk antibiotics; WBC 22,000/µL, creatinine 2.2 mg/dL (baseline 1.0). He has hypotension. Severity assessment suggests fulminant C. difficile. Best initial regimen?

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