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If saline is being used as a carrier for vancomycin enemas, serum electrolytes should be closely monitored because of potential colonic electrolyte absorption and subsequent electrolyte abnormalities, most notably hyperchloremia. If hyperchloremia occurs, a carrier with a lower concentration of chloride (e.Ringers Lactate) may be utilized. This combined approach and dosing strategy is based upon the rationale of ensuring effective delivery of therapeutic concentrations of antimicrobial therapy to the site of infection.
A major challenge in the management of severe, complicated CDI is the inability to predict in which patient medical therapy will fail, and lack of consensus on the indications or timing of surgery except the very rare complication of colonic perforation.