Regarding Management Of Clostridium difficile diarrhea (Pseudomembranous colitis)

A 78-year-old woman develops profuse, offensive watery diarrhea following a course of co-amoxiclav. A diagnosis of Clostridium difficile diarrhea is made. On examination she is haemodynamically stable, afebrile and has no abdominal signs. What is the most appropriate first-line therapy?
A. Oral vancomycin for 7 days
B. Oral metronidazole for 10-14 days
C. Oral metronidazole + vancomycin for 10-14 days
D. Oral metronidazole for 7 days
E. Probiotic yoghurt for 14 days

Answer:
B. Oral metronidazole for 10-14 days

Discussion: Clostridium difficile is a Gram positive rod often encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis. Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics. Clindamycin is historically associated with causing Clostridium difficile but the aetiology has evolved significantly over the past 10 years. Second and third generation cephalosporins are now the leading cause of Clostridium difficile.

Clinical Features:

• Diarrhoea 
• Abdominal pain 
• A raised white blood cell count is characteristic 
• If severe toxic megacolon may develop 

Diagnosis:  is made by detecting Clostridium difficile toxin (CDT) in the stool

Management:
 first-line therapy is oral metronidazole for 10-14 days
 if severe or not responding to metronidazole then oral vancomycin may be used
 for life-threatening infections a combination of oral vancomycin and intravenous metronidazole should be used