A 76-year-old woman develops profuse diarrhea 5 days after ceftriaxone for pneumonia. She is hypotensive, lactate is 4.2 mmol/L, WBC is 32 x 10^9/L

Question

A 76-year-old woman develops profuse diarrhea 5 days after ceftriaxone for pneumonia. She is hypotensive, lactate is 4.2 mmol/L, WBC is 32 x 10^9/L and creatinine has doubled. CT abdomen shows pancolitis with colonic dilation of 6.5 cm. Stool NAAT is positive for toxigenic C difficile. What is the most appropriate management?

Accepted Answer

High-dose oral vancomycin plus intravenous metronidazole and urgent surgical consultation

Answer

Fecal microbiota therapy as immediate first-line treatment in shock

Answer

Loperamide and oral hydration

Answer

Discharge with probiotics

Answer

Oral metronidazole alone as preferred therapy

Fulminant Clostridioides difficile colitis — RCPSC IM MCQ