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Antibiotic-associated diarrhoea — GPhC CRA MCQ

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ModerateGI TherapeuticsAntibiotic-associated diarrhoeaGPhC CRA

A 70-year-old woman presents to the pharmacy asking for loperamide for diarrhoea. She has had watery stools for two days. On questioning, she mentions she recently completed a course of co-amoxiclav for a chest infection. What is the most appropriate action?

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Correct answer: E — Refuse the sale of loperamide and refer to the GP urgently as the diarrhoea may be caused by Clostridioides difficile infection

Diarrhoea following antibiotic use, particularly in elderly patients and after broad-spectrum antibiotics such as co-amoxiclav, should raise suspicion of Clostridioides difficile infection. Loperamide is contraindicated in suspected C. difficile infection as it reduces gut motility and can worsen the condition by preventing toxin clearance. The patient should be urgently referred to her GP for stool testing and appropriate management.

Reference: BNF; NICE CKS Diarrhoea