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Psittacosis — SCE Infectious Diseases MCQ

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HardRespiratory InfectionPsittacosisSCE Infectious Diseases

A patient with toxin-positive C. difficile colitis has toxic megacolon, shock and ileus. Urgent surgical and microbiology review is underway. Which initial specialist antimicrobial approach accords with NICE NG199?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: AEnteral vancomycin 500 mg QDS plus IV metronidazole 500 mg TDS, adding rectal vancomycin if ileus limits delivery

Explanation lettering: D = shown as A · A = shown as C · E = shown as D · C = shown as E

D is correct. Life-threatening CDI needs urgent specialist and surgical input; NICE lists high-dose enteral vancomycin plus IV metronidazole, with rectal vancomycin considered when ileus impairs delivery. A and B are non-fulminant pathways. C uses an unreliable enteral route and inadequate regimen in ileus. E bypasses immediate antimicrobial and surgical management of toxic megacolon.

Reference: NICE NG199: C. difficile infection antimicrobial prescribing: https://www.nice.org.uk/guidance/ng199/chapter/Recommendations