Diarrhea is common in the neutropenic patient, with common causes including chemotherapy-induced mucositis and antibiotics. Only a fraction of these cases reflect C. difficile colitis, but this can be clinically severe, especially when ileus and abdominal dis-tention develop. Bacteremias due to enteric flora are more likely to occur from disruption of colonic mucosa. As febrile neutropenic patients requireongo-ing antibiotic therapy, treatment of C. difficile colitis is challenging. In addition to therapy with oral metronidazole (or oral vancomycin in the patient who has failed metronidazole), it may be helpful to change the antibiotic regimen to omit clindamycin or cephalosporins. If the patient is unable to take oral medication or has severe ileus, i.v. metronidazole is preferred.
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