Clostridium difficile

Question 1

typical history of a patient with c.diff ?

Answer 1

recent Hx of antibiotic use
PPI also a risk factor

diarrhoea, abdominal pain and raised WCC

Question 2

how would you confirm diagnosis of c.diff ?

Answer 2

stool clostridium difficile toxin

Question 3

what does c.diff antigen detected in the stool indicate ?

Answer 3

presence of c.diff but not active infection

Question 4

1st line treatment for c.diff ?

Answer 4

oral metronidazole for 10-14 days

Question 5

1st line treatment for severe c.diff ?

Answer 5

oral vancomycin

Question 6

1st line treatment for life threatening c.diff ?

Answer 6

oral vancomycin + IV metrondiazole

Question 7

classification of severity of c.diff ?

Answer 7

mild - normal WCC

moderate;

• raised WCC (> 15 x 10(9))
• typically 3-5 loose stool per day

severe;

• raised WCC
• rapid increase in creatinine (> 50% baseline)
• temp > 38.5
• evidence of severe colitis on radiological imaging or abdo examination

life-threatening;

• hypotension
• partial or complete ileus
• toxic megacolon
• severe colitis on CT

Question 8

treatment for 2nd episode of c.diff ?

Answer 8

vancomycin