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C. difficile Infection — Medical Practice MCQ

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HardInfectious DiseasesC. difficile Infection

A 58-year-old with suspected C. difficile colitis has ileus, leukocytosis 32,000/µL, and creatinine 230 µmol/L. Optimal initial therapy?

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Correct answer: A — Oral vancomycin 500 mg QID plus IV metronidazole 500 mg q8h (consider rectal vancomycin)

For fulminant CDI (hypotension/shock, ileus, megacolon, or severe labs), IDSA/SHEA recommend high-dose oral/NG vancomycin plus IV metronidazole, and consider rectal vancomycin if ileus. Fidaxomicin alone, metronidazole monotherapy, antidiarrheals, or delay are inappropriate.

Reference: IDSA/SHEA Focused Update (2021): Clostridioides difficile Infection