Approximately 20% of patients with pseudomembranous colitis relapse, usually 2 weeks to 2 months after treatment. This is related to the persistence of C.difficile spores that are not killed by antibiotic therapy, rather than to metronidazole resistance, hence recurrence of disease should be treated with a second course of oral metronidazole.
If he fails to respond to a second course of oral metronidazole the second line agent would be oral (not intravenous) vancomycin.
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