C. diff Flashcards
Clinical Vignette:
A 56-year-old man presents with diarrhea and abdominal pain. Lab tests reveal his albumin levels are 2.9g/dL, and his WBC count is 16,000 cells/mm^3. What would be the appropriate treatment?
Choices:
A. Metronidazole 500 mg PO TID × 10 days
B. Vancomycin 125 mg PO QID × 10 days
C. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h
D. Fecal microbiota transplant
Correct Answer:
B. Vancomycin 125 mg PO QID × 10 days
Explanation:
A is incorrect. The patient has a low albumin (<3g/dL) and high WBC (>15,000 cells/mm^3), which qualifies as severe, not mild-to-moderate.
B is correct. Given the albumin and WBC levels, the patient falls under the “severe” category, requiring vancomycin.
C is for severe and complicated cases, not applicable here.
D is generally reserved for recurrent cases.
Memory Tool:
Think “Van for the Severe Man” to remember Vancomycin for severe cases.
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
Understanding the treatment for different severities of C. difficile is essential for appropriate patient management.
Clinical Vignette:
A 49-year-old woman was successfully treated for C. difficile but now presents with symptoms of another episode within 7 weeks of completing her therapy. What is the recommended treatment?
Choices:
A. Metronidazole pulse regimen
B. Repeat vancomycin or metronidazole pulse regimen
C. Fecal microbiota transplant after one recurrence
D. Vancomycin PR (500 mg in 500 mL of saline as enema QID)
Correct Answer:
B. Repeat vancomycin or metronidazole pulse regimen
Explanation:
A is incomplete; either vancomycin or metronidazole could be repeated.
B is correct as per guidelines for recurrence within 8 weeks.
C is incorrect; fecal transplant is considered after three recurrences.
D is used in severe and complicated cases, not recurrent.
Memory Tool:
“Back in 8? Repeat the Plate” - to remember to repeat the initial treatment if recurrence is within 8 weeks.
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
Recurrence is a frequent problem in C. difficile, and knowing the guidelines for treatment is crucial.
Clinical Vignette:
A 60-year-old female with a history of alcoholism is unable to take metronidazole due to potential liver toxicity. Her symptoms are consistent with a mild to moderate C. difficile infection. What should be the first-line treatment?
Choices:
A. Vancomycin 125 mg PO QID × 10 days
B. Vancomycin 500 mg PO QID × 10 days
C. Metronidazole 500 mg PO TID × 10 days
D. Surgical consultation
Correct Answer:
A. Vancomycin 125 mg PO QID × 10 days
Explanation:
A is correct. In cases where metronidazole can’t be taken, vancomycin 125 mg is the alternative.
B is for severe and complicated cases.
C should not be used due to the patient’s history of alcoholism and potential liver toxicity.
D is indicated only for severe and complicated cases requiring surgical consultation.
Memory Tool:
Vancomycin is the “Van you CAN when you CAN’T with Metronidazole.”
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
Knowing alternative treatments is important for patient safety and effective disease management.
Clinical Vignette:
A 43-year-old man with mild to moderate C. difficile shows no improvement after 6 days on metronidazole. What’s the next course of action?
Choices:
A. Continue metronidazole for another 4 days
B. Switch to vancomycin for 10 days
C. Add vancomycin to the ongoing metronidazole treatment
D. Consider fecal microbiota transplant
Correct Answer:
B. Switch to vancomycin for 10 days
Explanation:
A is incorrect; guidelines suggest switching if no improvement is seen after 5–7 days.
B is correct; if there’s no improvement, a switch to vancomycin is recommended.
C is not a recommended combination in this case.
D is reserved for recurrent cases after three recurrences.
Memory Tool:
“If Metron doesn’t Settle, Vanco will Net-tle” — meaning switch to Vancomycin if Metronidazole doesn’t show improvement.
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
Treatment modification based on patient response is vital for managing C. difficile effectively.
Clinical Vignette:
A 75-year-old man is admitted to the ICU with hypotension, a fever of 39°C, and a WBC count of 36,000 cells/mm^3. What treatment should be initiated for his C. difficile infection?
Choices:
A. Vancomycin 125 mg PO QID × 10 days
B. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h and vancomycin PR (500 mg in 500 mL of saline as enema QID)
C. Metronidazole 500 mg PO TID × 10 days
D. Surgical consultation only
Correct Answer:
B. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h and vancomycin PR (500 mg in 500 mL of saline as enema QID)
Explanation:
A is for severe but not complicated cases.
B is correct as the patient has severe and complicated C. difficile, requiring a multi-drug regimen.
C is generally for mild to moderate cases and is insufficient here.
D is not enough; medical therapy should accompany surgical consultation.
Memory Tool:
“For Complications, Pull out All the Stops” — signifying the multi-drug approach for severe and complicated cases.
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
The treatment of severe and complicated cases of C. difficile often involves a combination of medications, and it’s crucial to recognize this.
Clinical Vignette:
A 50-year-old woman presents with her fourth recurrence of C. difficile within a year. What is the next recommended step?
Choices:
A. Continue with the previous treatment
B. Surgical consultation
C. Fecal microbiota transplant
D. Start a new antibiotic not previously used
orrect Answer:
C. Fecal microbiota transplant
Explanation:
A is not advised given the frequent recurrences.
B may not be warranted yet.
C is correct. Fecal microbiota transplant is considered after three recurrences.
D is not a standard guideline recommendation for this situation.
Memory Tool:
“Three Strikes, You’re Out” — After three recurrences, consider a fecal microbiota transplant.
Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)
Rationale:
Recurrent C. difficile can be challenging to manage, and it’s crucial to know when fecal microbiota transplant becomes an option.
