]> 2026-07-31T09:41:20+00:00 WBR1115 0 en Stool studies for Clostridium difficle toxin Oral metronidazole Therapy for non-severe C. difficile infection (CDI) usually consists of oral metronidazole for 10-14 days. This patient has severe C. difficile infection and hence should be treated with vancomycin. Oral vancomycin Oral vancomycin (125 mg four times daily) is the preferred therapy for severe or refractory cases and hence the right option. Intravenous metronidazole Intravenous metronidazole is used along with oral vancomycin in the treatment complicated disease with peritoneal signs and abdominal distension. Colonoscopy and biopsy Treatment should be promptly initiated in patients with severe C. difficile infection with high clinical suspicion. Emergency Room A 50 year old male comes to the emergency department with complaints of abdominal pain, loose watery stools and fever for the past 2 days. The patient has no nausea and vomiting and denies any blood or mucus in stools. His past history is significant for treatment of upper respiratory tract infection with penicillin two weeks back. He denies any recent travel outside the country or contacts with sick patients. He is a known diabetic and hypertension on regular medications. He is not a smoker and does not consume alcohol. On examination his vitals are pulse: 102/min, BP: 110/80 mmHg, temperature: 38 degree Celsius. His mucus membrane is dry. Abdominal examination reveals diffuse tenderness and active bowel sounds with no distension. Initial lab evaluation shows Hb: 12 g/dl, RBC: 4.5 million/mm3, WBC: 18,000/mm3, sodium: 147 mEq/L, potassium: 3 mEq/L, chloride: 107 mEq/L, BUN: 50 mg/dl, serum creatinine: 2 mg/dl and serum albumin 2.5 g/dl. Which of the following would be the most appropriate next step in the management of this patient? C Gastrointestinal 2020-10-28T02:39:53Z 2459150.6110301 WBR1115