Antibiotics: Clostridioides difficile infection: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antibiotics: Clostridioides difficile infection

Sample item

A 68-year-old woman treated with clindamycin for a skin abscess develops profuse watery diarrhoea on day 6, with abdominal cramping, fever and leucocytosis. Stool C. difficile toxin is positive. This is her first episode. What is the most appropriate treatment?

AContinue clindamycin and add a probioticBLoperamide to reduce stool frequencyCIntravenous vancomycinDStop clindamycin if possible and give oral vancomycin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Stop clindamycin if possible and give oral vancomycin

Antibiotic-associated colitis from toxin-producing C. difficile is treated by stopping the inciting antibiotic where possible and giving oral vancomycin (or fidaxomicin). Oral vancomycin is not absorbed and achieves high colonic concentration. Antimotility agents risk toxic megacolon.

Option by option

A. Continue clindamycin and add a probiotic
Continuing the offending antibiotic with only probiotics does not treat established infection.
B. Loperamide to reduce stool frequency
Antimotility drugs can precipitate toxic megacolon and are avoided.
C. Intravenous vancomycin
Intravenous vancomycin does not reach adequate luminal concentrations in the colon.
D. Stop clindamycin if possible and give oral vancomycin (correct)
Correct. Oral vancomycin acts in the colon, which is the site of infection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Stop clindamycin if possible and give oral vancomycin. Antibiotic-associated colitis from toxin-producing C.

Why is "Continue clindamycin and add a probiotic" not the answer?

Continuing the offending antibiotic with only probiotics does not treat established infection.

Why is "Loperamide to reduce stool frequency" not the answer?

Antimotility drugs can precipitate toxic megacolon and are avoided.

Why is "Intravenous vancomycin" not the answer?

Intravenous vancomycin does not reach adequate luminal concentrations in the colon.

What concept does this question test?

It tests Antibiotics: Clostridioides difficile infection in Pharmacology. difficile is treated by stopping the inciting antibiotic where possible and giving oral vancomycin (or fidaxomicin). Oral vancomycin is not absorbed and achieves high colonic concentration. Antimotility agents risk toxic megacolon.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antibiotics: Clostridioides difficile infection?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.