DIARRHOEA

Question 1

C.diff

Answer 1

Clostridioides difficile (C. difficile) infection occurs when:
- normal gut microbiota are suppressed,
- levels of toxin producing strains of C. difficile flourish
- toxin damages the lining of the colon = DIARRHOEA

Question 2

C DIFF symptoms

Answer 2

Diarrhoea

Question 3

Common C.diff causing antibiotics

Answer 3

Macrolide (Clindamycin)
Cephalosporins (esp 3rd + 4th gen)
Fluoroquinolones (cipro, levo)
Broad spectrum e.g. co-amoxiclav
PPI

Question 4

Which Abx is not strongly associated with C.diff resistance?

Answer 4

aminoglycosides, doxycycline

Question 5

Factors that increase C.diff infection risk

Answer 5

Longer duration of abx treatment.
Concurrent use of multiple antibacterials
Multiple courses
PPIs
65+
Prolonged hospitalisation

Question 6

C. Diff treatment general

Answer 6

1. FIRST: Vancomycin
2. SECOND: Fidaxomicin
3. Life-threatening: Vancomycin and IV metronidazole

Question 7

First episode of mild, moderate, or severe C. difficile infection

Answer 7

1st = Vancomycin 125 mg QDS for 10 days
2nd = Fidoxamicin 200 mg BD for 10 days

Question 8

Further episode - within 12 weeks (relapse)

Answer 8

Fidoxamicin

Question 9

Further episode - after 12 weeks (recurrence)

Answer 9

Vancomycin or Fidoxamicin

Question 10

Life-threatening C.diff

Answer 10

Vancomycin 500 mg QDS AND Metronidazole 500 mg IV TDS for 10 days

Question 11

What medication is contraindicated in C.diff

Answer 11

loperamide

Question 12

C. Diff duration of treatment

Answer 12

10 days

Question 13

C.diff and Fe

Answer 13

Stop iron
Fe stimulates growth of C.diff with increased colony formation units

Question 14

Traveller’s diarrhoea

Answer 14

Standby: Azithromycin
Prophylaxis/treatment: bismuth subsalicylate