C. difficile Infection — Medical Practice MCQ

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ModerateInfectious DiseasesC. difficile Infection

A 67-year-old with suspected C. difficile infection (first episode, non-severe). Best initial therapy?

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Correct answer: D — Vancomycin 125 mg QID 7 days

Oral vancomycin is the first-line treatment in current UK practice for a first episode of mild, moderate or severe Clostridioides difficile infection. The recommended dose is vancomycin 125 mg orally four times daily; metronidazole is no longer preferred as initial therapy, fidaxomicin is generally reserved for treatment failure/relapse or specified recurrent disease pathways, and probiotics are not a substitute for antibiotic treatment. Among the options, C is the best answer because it gives the correct first-line agent and dose. Note: current NICE guidance specifies a 10-day course rather than 7 days, so an ideal UK exam option would read “vancomycin 125 mg QID for 10 days.”

Reference: NICE NG199: Clostridioides difficile infection: antimicrobial prescribing, 2021, updated current online version. https://www.nice.org.uk/guidance/ng199/chapter/Recommendations