How should you manage this patient?

NEET PG NEET PG MCQs
#1

A 63 year old gentleman has just complete a course of coamoxiclav for a lower respiratory tract infection. He present very unwell with severe diarrhoea which is green in colour and is foul smelling. There is no blood or mucous. Samples are sent and a flexible sigmoidoscopy is performed and reveals a colitis. There is evidence of dilatation of his large bowel on abdominal x-ray. How should you manage this patient?

  1. Await stool sample results before commencing treatment
  2. IV fluids
  3. IV fluids and oral metronidazole
  4. IV fluids and IV vancomycin
  5. IV fluids and oral ciprofloxacin

explanation

This patient is very likely to have C. Difficile infection given the history of recent coamoxiclav and the green colour of the stool. It can lead to toxic dilatation and leads to pseudomembranous colitis. Patients should be fluid resuscitated and treated with metronidazole ideally orally. Vancomycin orally is also utilised in the treatment however it is not used IV.