A 64-year-old woman presents to her primary care physician reporting five days of profuse, watery diarrhea. She experiences 6 to 8 loose bowel movements daily along with mild abdominal cramping. She denies fever, nausea, vomiting, or hematochezia. Medical history is significant for a sinus infection treated with a course of amoxicillin-clavulanate three weeks ago. Vital signs are within normal limits. Abdominal examination reveals mild, diffuse tenderness to deep palpation without guarding or rebound. Stool testing confirms the presence of Clostridioides difficile toxin. Which of the following is the most appropriate next step in management?
- APrescribe intravenous vancomycin
- BPrescribe oral metronidazole
- Prescribe oral vancomycinAnswer
- DPrescribe oral ciprofloxacin
- EPrescribe oral loperamide
Answer
Prescribe oral vancomycin
The correct approach is to prescribe oral vancomycin. This patient is presenting with an initial, non-severe episode of Clostridioides difficile infection (CDI) triggered by recent amoxicillin-clavulanate use. The first-line therapy for an initial episode of CDI is a 10-day course of either oral vancomycin or oral fidaxomicin. These medications act locally within the colonic lumen to eradicate the pathogen with minimal systemic absorption.
Step-by-Step Solution
Key Concept
The first-line treatment for an initial episode of Clostridioides difficile infection is oral vancomycin or oral fidaxomicin.