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Fulminant CDI Toxic Megacolon — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsFulminant CDI Toxic MegacolonSCE Infectious Diseases

A patient with life-threatening C. difficile colitis has ileus, toxic megacolon and deterioration despite enteral vancomycin. What escalation is required?

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

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Correct answer: BAdd 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