Case 10: Management

Choose the next best steps in management:

How would you manage this patient with severe/complicated C difficile colitis with toxic megacolon? ( more than 1 choice may apply). 
Oral vancomycin 125 mg orally 4 times per day
Incorrect. This would be suitable for the treatment of non-severe C difficile primary or recurrent infection.
Oral fidaxomicin 200 mg twice daily for 10 days
Incorrect. This would be suitable for the treatment of non-severe C difficile primary or recurrent infection.
Oral vancomycin 500mg every 6 hours daily for the first 48–72 hours in combination therapy with parenteral metronidazole 500 mg every 8 hours
Correct! IDSA 2017 and ACG 2021 guidelines recommend the above treatment option for fulminant C difficile infection.
Vancomycin enemas
Correct! Enemas can be prescribed in addition to oral vancomycin in the presence of ileus.
Subtotal Colectomy and loop ileostomy with anterograde intraluminal vancomycin pushes
Incorrect.  ACG 2021 guidelines recommend the above surgical options in patients refractory to medical treatment or in the presence of bowel perforation.
Fecal microbial transplant
Correct! 2021 ACG guidelines recommend that FMT be considered for patients with severe, fulminant or recurrent CDI refractory to antibiotic therapy and for patients who are deemed poor surgical candidates.


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Case 10 Index:
Introduction
Physical Exam
Diagnostic Testing

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