Metronidazole is considered what role in the management of C. difficile infection?

• A. First-line therapy
• B. Alternative for milder disease
• C. Prophylaxis
• D. Not used

Answer: (B)

Metronidazole in C. difficile infection sits lower in the treatment hierarchy and is considered an option when the disease is mild and other first-line agents aren’t available or suitable. In current practice, vancomycin or fidaxomicin are preferred for initial episodes because they generally achieve higher cure rates and lower relapse, especially as disease severity increases. Metronidazole has comparable effectiveness in milder cases but overall lower efficacy and a higher relapse risk, plus potential side effects and drug interactions, so it’s reserved as an alternative rather than the primary choice. It’s not a prophylactic measure, and it’s not the recommended first-line in most guidelines, which is why describing it as an alternative for milder disease best fits its role.