skip to main content

Fulminant CDI — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectious DiseasesFulminant CDIRACP Adult Medicine

A 55-year-old man with Clostridioides difficile infection on oral vancomycin develops fulminant colitis with toxic megacolon (colonic diameter 8 cm). He has peritonitis and WCC 35 × 10⁹/L. What is the critical management?

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

Reveal the answer and explanation

Correct answer: D — Faecal microbiota transplantation

Fulminant CDI with toxic megacolon requires escalated medical therapy (high-dose oral/NG vancomycin 500 mg QID + rectal vancomycin 500 mg in 100 mL NS QID + IV metronidazole 500 mg 8-hourly) AND urgent surgical consultation for possible colectomy. Mortality of fulminant CDI exceeds 30% and increases with delayed surgery. Surgical options include subtotal colectomy with end-ileostomy or diverting loop ileostomy with colonic lavage (less morbid). FMT is NOT appropriate for fulminant disease.

Reference: eTG – 2025 – Antibiotic Guidelines; IDSA/SHEA – 2021 – CDI Guidelines