Board Review: Bugs and Drugs


70 year old male presents with complaint of cramping lower abdominal pain with 6 episodes of loose large volume bowel movements in the last 24 hours. He notes concomitant mucus in stools.  He was recently hospitalized for pneumonia two weeks earlier. His vitals are BP 110/60, HR 125, Temp 102.6 (orally), RR 18, SpO2 100% RA. On exam, patient with diffuse abdominal tenderness. Pertinent labs include: WBC- 28 x103, Sodium of 130, and Cr of 3.4 which was normal at discharge. What therapy would you initiate for this patient prior to admitting this patient?


A. Loperamide

B. PO Vancomycin 500 mg + IV Metronidazole 500 mg

C. PO Metronidazole 500 mg 

D. IV Vancomycin 1 gm

E. PO Vancomycin 125 mg























E. PO VANCO 125 MG. Patient with Cdiff. Initial recommended antibiotic per IDSA guidelines is PO Vanc. 





Kelly, C. et al. “Clostridiodes (formerly Clostridium) difficile infection in adults:

            Treatment and Prevention.” Aug 2019 <>. Sept 12



Lamont, J  et al.Clostridiodes (formerly Clostridium) difficile infection in adults

            Clinical manifestations and diagnosis.” Aug 2019 <>. 

            Sept 12 2019. 


McDonald, Clifford, et al. “ Clostridium Difficile.” Clinical Infectious Diseases

            Volume 66, Issue 7, 1 April 2018, Pages e1–e48. 15 February 2018