Fulminant CDI Toxic Megacolon — SCE Infectious Diseases MCQ
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Correct answer: B — Add intravenous metronidazole and rectal vancomycin; seek surgical review
The best answer is “Add intravenous metronidazole and rectal vancomycin; seek surgical review”. Ileus impairs delivery of oral treatment to the distal colon; combined-route therapy and early surgical decision-making are essential before perforation or refractory shock. NICE defines severity and recurrence and gives episode-specific antibacterial regimens, medicine review and escalation advice.
Reference: NICE NG199: Clostridioides difficile infection: https://www.nice.org.uk/guidance/ng199/chapter/Recommendations