q????? - akshaya007

[ArchivalUser]

A 64-year-old man with sinusitis is prescribed amoxicillin for 14 days. On the tenth day of treatment he develops foul-smelling, voluminous, nonbloody diarrhea. Stool studies are positive for Clostridium difficile toxin. He is given a 7-day course of metronidazole, after which his diarrhea resolves. repeat stool studies for Clostridium difficile at this time are negative. Three weeks later, the patient again presents with voluminous watery diarrhea and repeat stool studies are again positive for Clostridium difficile toxin. Which of the following is the most appropriate next step in management?

A. Begin intravenous vancomycin
B. Begin oral vancomycin
C. Repeat amoxicillin course
D. Repeat metronidazole course
E. Send the patient for colonoscopy

[ArchivalUser]

D!

[ArchivalUser]

C Difficile initial treatment is Metronidazole
If resolved and RECURS, repeat metronidazole (choice D)

Oral vancomycin reserved for:
FAILED metronidazole treatment (recurrence doesn't mean failed, failed treatment means it NEVER resolved)

Reference Kaplan IM 2017 (page 94)

[ArchivalUser]

The answer is D repeat a course of metronidazole.