GIM Question 39 Instructor

A patient on your ward is being treated with ceftriaxone for pneumonia. Two days after antibiotic administration, she begins to experience watery diarrhea, but no fever.Clostridium difficile PCR testing on a stool sample comes back positive. The patient’s CBC, lytes and creatinine are within normal limits.

  1. What is your initial treatment for this patient?
    This patient has a mild C. difficile infection.
    The treatment indicated is Metronidazole 500mg PO TID for 10-14days.
    Second line treatment is Vancomycin 125mg PO QID for 10-14days.
  2. How would your management change if the patient developed a fever, an elevated WBC count, and hypotension?
    A patient with C. difficile presenting with fever, an elevated WBC count, and hypotension is exhibiting severe/complicated C. difficile infection.
    The treatment in this case would be metronidazole 500mg IV q8h AND vancomycin 125-500mg PO QID.

Bagdasarian N, Rao K and Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systemic review. JAMA. 2015;313:398-408.

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