A 62-Year-Old Man Comes to the Emergency Department Due to a 3-Day

question 668

Multiple Choice

A 62-year-old man comes to the emergency department due to a 3-day history of worsening diarrhea and abdominal pain.  The patient has had 3-4 watery stools a day with no blood or mucus.  The pain is mild, located in the lower abdominal quadrants, and partially relieved with bowel movements.  He has had no fever, nausea, or vomiting.
The patient had similar symptoms 6 weeks ago after antibiotic treatment for pneumonia.  He was found to have Clostridium difficile infection and was treated with oral vancomycin.  The patient had been feeling well after finishing the 10-day treatment until the symptoms recurred.  Other medical issues include hypertension, type 2 diabetes mellitus, hyperlipidemia, and depression.
Temperature is 37.2 C (99 F) , blood pressure is 110/80 mm Hg, and pulse is 88/min.  The abdomen is soft with mild tenderness in the periumbilical and left lower quadrant.  There is no rebound tenderness or rigidity.
Laboratory results are as follows:
Stool PCR for C difficile is positive.  Which of the following is the best therapy for this patient?

• A)Intravenous metronidazole plus oral vancomycin
• B)Oral metronidazole
• C)Oral vancomycin followed by rifaximin
• D)Oral vancomycin with slow taper
• E)Probiotic therapy

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