]> 2026-07-31T11:51:14+00:00 WBR0889 0 en Observe and counsel No treatment is indicated for patients who have a positive C. diff toxin assay without symptoms. Administer oral metronidazole as prophylaxis for the next 7 days Oral metronidazole is indicated as an initial treatment of a mild form of C. diff infection. It is usually administered for 10-14 days. Administer oral vancomycin as prophylaxis for the next 2 weeks This is reserved for severe cases, and also for those who experienced a relapse after a course of metronidazole treatment. The use of vancomycin is limited due its expensive cost, and also the risk of developing vancomycin-resistant enterococci (VRE). Schedule colonoscopy immediately This is reserved for cases with a high suspicion of C. diff infection despite negative laboratory assay, failure of response to drug treatment or in cases where prompt diagnosis is required. This reveals the presence of a pseudomembrane in the colon. Order an abdominal CT This demonstrates a pronounced thickening of the colonic wall in patients with pseudomembranous colitis. Clostridium difficile is an organism normally seen in the intestine. However, it may overgrow when you take antibiotics which kill a lot of gut flora which impede their growth in the intestine. The bacteria release a powerful toxin that causes the lining of the colon to become inflamed and bleed. The symptoms experienced during an acute infection are offensive-smelling watery diarrhea, fever, and abdominal pain. Toxic megacolon may result in severe cases which involves surgery. A positive Clostridium difficile toxin assay may signify an acute infection or a recent infection. However, treatment is not indicated for an asymptomatic patient with a positive assay. Educational Objective: No treatment is indicated for patients who have a positive C. diff toxin assay without symptoms.<br/> '''Educational Objective:''' <br/> '''References:''' Community Medical Health Center A 65-year old man comes to the outpatient gastroenterology clinic for a routine check-up. He was admitted and treated 2 months ago for community acquired pneumonia. He has no complaint today and his vitals are within normal limit. His laboratory investigations are also normal except for a positive Clostridium difficile toxin assay. What is the best next step to take in the management of this patient? A Infectious Disease 2020-10-28T02:00:08Z 2459150.5834259 WBR0889