A Patient with Necrotising fasciitis is treated with antibiotics and debridement. He got discharged on wound recovery. Now he came back after 10 days with diarrhea and fever. The following are done except.
- A. Continue same antibiotic
- B. Stop Loperamide 2mg
- C. Metronidazole is the Drug of Choice
- D. Washing hands with alcohol based hand sanitizers are superior to washing hands with soap to stop the spread of diarrhea
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Ans: Continue Same antibiotics Ref: Schwartz 10th Edition page 1222, Studies from Interne Sources. Explanation: This is a case of Pseudomembranous colitis ( Clostridum Difficle Colitis)
Introduction: • C. difficile colitis is extremely common and is the leading cause of nosocomially acquired diarrhea. • The spectrum of disease ranges from watery diarrhea to fulminant, life-threatening colitis. C. difficile is carried in the large intestine of many healthy adults. • Colitis is thought to result from overgrowth of this organism after depletion of the normal commensal flora of the gut with the use of antibiotics.
Although clindamycin was the first antimicrobial agent associated with C. difficile colitis, almost any antibiotic may cause this disease.
Predisposing factors: • Moreover, although the risk of C. difficile colitis increases with prolonged antibiotic use, even a single dose of an antibiotic may cause the disease. • Immunosuppression, medical comorbidities, prolonged hospitalization or nursing home residence, and bowel surgery increase the risk.
Diagnosis: • Diagnosis of this disease was traditionally made by culturing the organism from the stool. • Detection of one or both toxins (either by cytotoxic assays or by immunoassays) has proven to be more rapid, sensitive, and specific. • The diagnosis may also be made endoscopically by detection of characteristic ulcers, plaques, and pseudo membranes.
Management: • Immediate cessation of the offending antimicrobial agent. • Mild disease treated as outpatients with a 10-day course of oral metronidazole. • Oral vancomycin is a second-line agent used in patients allergic to metronidazole or in patients with recurrent disease. • Loperamide and other motility agents are contraindicated as they stagnate the toxin in Lumen and cause more symptoms. • Reintroduction of normal flora by ingestion of probiotics or stool transplantation has been suggested as a possible treatment for recurrent or refractory disease. • Fulminant colitis, characterized by septicemia and/or evidence of perforation, requires emergent laparotomy. A total abdominal colectomy with end ileostomy may be lifesaving.