A physician is evaluating a 64-year-old male patient who reports the sudden onset of profu… — USMLE Step 2 CK

A physician is evaluating a 64-year-old male patient who reports the sudden onset of profuse, watery diarrhea and lower abdominal cramps that began three days ago. The patient recently completed a 10-day course of clindamycin for a dental abscess. He currently experiences up to nine bowel movements daily. His temperature is $37.9^\circ\text{C}$ ( $100.2^\circ\text{F}$ ), pulse is $92/\text{min}$ , and blood pressure is $118/76\text{ mm Hg}$ . Physical examination of the abdomen reveals mild, diffuse tenderness without rebound or guarding. Laboratory results show a leukocyte count of $15,500/\text{mm}^3$ . Stool testing is positive for *Clostridioides difficile* toxin via nucleic acid amplification testing. Which of the following is the most appropriate pharmacologic intervention for this patient's current condition?

A
Administration of intravenous vancomycin
Administration of oral vancomycinCevap
C
Administration of oral metronidazole
D
Administration of intravenous ceftriaxone
E
Administration of oral ciprofloxacin

Cevap

Administration of oral vancomycin

The patient has an initial episode of Clostridioides difficile infection (CDI), likely precipitated by recent clindamycin use. According to current clinical guidelines, the first-line treatment for an initial episode of CDI is oral vancomycin or oral fidaxomicin. Oral vancomycin is poorly absorbed, allowing it to achieve very high, effective intraluminal concentrations directly at the site of the infection in the colon.

Adım Adım Çözüm

Analyze the patient's clinical presentation and laboratory results.

The patient has a history of recent clindamycin use and presents with acute watery diarrhea. Stool testing confirms the presence of Clostridioides difficile toxin.

Identifying the correct diagnosis is the prerequisite for selecting the appropriate targeted therapy.

Determine the severity and specific treatment indication for the identified infection.

This is an initial episode of Clostridioides difficile infection. The standard of care requires targeted oral antibiotic therapy.

Treatment guidelines dictate specific medications based on whether it is an initial or recurrent episode, and disease severity.

Select the most appropriate pharmacologic agent from the available options.

Oral vancomycin is chosen over the alternatives because it achieves high luminal concentrations and is recommended as first-line therapy.

Intravenous vancomycin does not reach the colonic lumen, and oral metronidazole is no longer considered first-line for initial episodes.

Anahtar Kavram

The first-line treatment for an initial episode of Clostridioides difficile infection is oral vancomycin or oral fidaxomicin.

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