Oral rehydration solution — GPhC CRA MCQ

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HardGastrointestinal TherapeuticsOral rehydration solutionGPhC CRA

A 69-year-old develops frequent watery diarrhoea and abdominal cramps after six days of co-amoxiclav. They are afebrile but frail and ask for loperamide. What should the pharmacist do?

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Correct answer: B — Decline loperamide and arrange same-day C. difficile infection assessment

Decline loperamide and arrange same-day C. difficile infection assessment: Recent broad-spectrum antibiotics and new profuse diarrhoea raise C. difficile risk; antimotility treatment can mask or worsen severe colitis and assessment should not be delayed. Supply loperamide and review after the co-amoxiclav course has finished: Antimotility treatment is inappropriate in suspected C. difficile and the causative antibiotic needs clinical review. Use a probiotic alone and review if diarrhoea persists for two weeks: A probiotic is not a substitute for prompt diagnostic and treatment assessment in a frail high-risk patient. Use leftover metronidazole and continue the prescribed co-amoxiclav course: Leftover antimicrobials should not be used and current C. difficile treatment requires a prescribed regimen. Continue co-amoxiclav and reassess when antibiotic treatment is complete: C. difficile and other antibiotic-associated diarrhoea commonly occur during exposure.

Reference: NICE NG199: Clostridioides difficile infection: https://www.nice.org.uk/guidance/ng199/chapter/Recommendations; BNF: loperamide hydrochloride: https://bnf.nice.org.uk/drugs/loperamide-hydrochloride/