05-09-2012, 08:02 AM
A 40-year-old woman was hospitalized 3 weeks ago for cholecystectomy and placed on antibiotics. During her recovery, she developed severe abdominal pain, which was diffuse and nonradiating and associated with diarrhea and fever. Physical examination was remarkable for diffuse abdominal tenderness. Her WBC count was found to be 45,000/mm3. On microscopic examination, there were no fecal leukocytes, and the stool was occult-blood negative. Clostridium difficile toxin was found to be positive. She was treated with 500 mg metronidazole orally four times a day for 10 days and was discharged home.
Two weeks later, she returns to the emergency department complaining of fever, abdominal pain, decreased appetite, and at least 20 watery bowel movements daily. On physical examination, she is febrile to 38 C and mildly tachycardic but has normal blood pressure. She is weak, with dry oral mucosa and sunken eyes. Her lungs are clear to auscultation, and no heart murmurs are heard. Her abdomen is diffusely tender with hyperactive bowel sounds, and stool is guaiac-negative. Extremities show no edema or cyanosis. What is the next best step in the management of this patient?
(A) Admit to the hospital with bowel rest and 500 mg metronidazole orally four times a day for 10 days
(B) Admit to the hospital with bowel rest and 125 mg vancomycin orally four times a day for 10 days
© Admit to the hospital with bowel rest and treat with 500 mg IV metronidazole every six hours for 10 days
(D) Admit to hospital with bowel rest and treat with 125 mg vancomycin IV every six hours for 10 days
(E) She can safely be sent home because the symptoms will resolve without further treatment
Two weeks later, she returns to the emergency department complaining of fever, abdominal pain, decreased appetite, and at least 20 watery bowel movements daily. On physical examination, she is febrile to 38 C and mildly tachycardic but has normal blood pressure. She is weak, with dry oral mucosa and sunken eyes. Her lungs are clear to auscultation, and no heart murmurs are heard. Her abdomen is diffusely tender with hyperactive bowel sounds, and stool is guaiac-negative. Extremities show no edema or cyanosis. What is the next best step in the management of this patient?
(A) Admit to the hospital with bowel rest and 500 mg metronidazole orally four times a day for 10 days
(B) Admit to the hospital with bowel rest and 125 mg vancomycin orally four times a day for 10 days
© Admit to the hospital with bowel rest and treat with 500 mg IV metronidazole every six hours for 10 days
(D) Admit to hospital with bowel rest and treat with 125 mg vancomycin IV every six hours for 10 days
(E) She can safely be sent home because the symptoms will resolve without further treatment