The Question
A 78-year-old man at a skilled nursing facility is evaluated for a 3-day history of profuse watery diarrhea and lower abdominal cramping. He has had up to 10 non-bloody stools per day. His medical history is notable for COPD and hypertension. Two weeks ago, he completed a 5-day hospital course of intravenous ceftriaxone and oral azithromycin for community-acquired pneumonia. On examination, his temperature is 38.4°C (101.1°F), heart rate is 105/min, and blood pressure is 110/70 mm Hg. His abdomen is soft and diffusely tender without peritoneal signs. Laboratory studies show a white blood cell count of 18,500/µL. His serum creatinine is 1.6 mg/dL; his baseline creatinine one month prior was 1.0 mg/dL. A stool nucleic acid amplification test is positive for Clostridioides difficile. Which of the following is the most appropriate initial therapy?
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A
Explanation
Clinical Pearl:
For an initial episode of severe Clostridioides difficile infection (defined by WBC ≥15,000/µL or creatinine ≥1.5 times baseline), oral fidaxomicin is the preferred guideline-recommended therapy due to lower rates of recurrence compared to oral vancomycin.
Explanation:
Infectious Disease
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