A patient admitted for hip fracture repair develops profuse watery diarrhoea after 5 days of cephalosporin treatment. Stool ELISA is positive for Clostridium difficile toxin B. The preferred first-line treatment is:
- A Oral vancomycin 125 mg four times daily for 10 days
- B Oral fidaxomicin 200 mg twice daily for 10 days ✓
- C IV metronidazole 500 mg three times daily
- D Oral rifaximin 400 mg twice daily
Explanation
Per current IDSA/SHEA (2021) and European guidelines, oral fidaxomicin 200 mg twice daily for 10 days is preferred first-line treatment for non-severe C. difficile infection (CDI) over oral vancomycin because of its narrower spectrum (preserving gut microbiota) and significantly lower recurrence rates (25% vs 12% recurrence in trials). Oral vancomycin 125 mg four times daily for 10 days remains an acceptable alternative. IV metronidazole is now considered inferior and is only used if oral therapy is not feasible. Rifaximin has a role in recurrence prevention.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.