RT Journal Article SR Electronic T1 Clostridium difficile-associated diarrhea in adults JF Canadian Medical Association Journal JO CMAJ FD Canadian Medical Association SP 51 OP 58 DO 10.1503/cmaj.1031189 VO 171 IS 1 A1 Susan M. Poutanen A1 Andrew E. Simor YR 2004 UL http://www.cmaj.ca/content/171/1/51.abstract AB CLOSTRIDIUM DIFFICILE is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy.