Gastrointestinal surgery: antibiotic-associated colitis treatment: practice question

A General Surgery 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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General Surgery · Gastrointestinal surgery: antibiotic-associated colitis treatment

Sample item

A 68-year-old woman develops profuse watery diarrhoea, fever and leucocytosis nine days after a course of clindamycin. Stool toxin assay is positive and colonoscopy shows yellow-white plaques on inflamed mucosa. This is her first episode. Which is the preferred initial treatment?

AOral vancomycin for 10 daysBOral ciprofloxacin for 10 daysCIntravenous vancomycin for 10 daysDLoperamide with oral rehydration

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

The answer and the reasoning

A. Oral vancomycin for 10 days

Clostridioides difficile colitis is treated with oral vancomycin or fidaxomicin, which act within the colonic lumen, together with stopping the inciting antibiotic. Systemic vancomycin does not reach the colonic lumen in useful concentration. Antimotility drugs and further fluoroquinolone exposure can worsen the disease.

Option by option

A. Oral vancomycin for 10 days (correct)
Correct. Oral vancomycin is poorly absorbed, so it achieves high luminal levels where the toxin-producing organism lives.
B. Oral ciprofloxacin for 10 days
Fluoroquinolones are themselves a recognised trigger for this colitis and are not a treatment for it.
C. Intravenous vancomycin for 10 days
Intravenous vancomycin is not excreted into the colonic lumen in adequate amounts and is therefore ineffective for this infection.
D. Loperamide with oral rehydration
Antimotility drugs prolong toxin contact with mucosa and risk toxic megacolon; rehydration alone does not treat the 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 General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Oral vancomycin for 10 days. Clostridioides difficile colitis is treated with oral vancomycin or fidaxomicin, which act within the colonic lumen, together with stopping the inciting antibiotic.

Why is "Oral ciprofloxacin for 10 days" not the answer?

Fluoroquinolones are themselves a recognised trigger for this colitis and are not a treatment for it.

Why is "Intravenous vancomycin for 10 days" not the answer?

Intravenous vancomycin is not excreted into the colonic lumen in adequate amounts and is therefore ineffective for this infection.

Why is "Loperamide with oral rehydration" not the answer?

Antimotility drugs prolong toxin contact with mucosa and risk toxic megacolon; rehydration alone does not treat the infection.

What concept does this question test?

It tests Gastrointestinal surgery: antibiotic-associated colitis treatment in General Surgery. Systemic vancomycin does not reach the colonic lumen in useful concentration. Antimotility drugs and further fluoroquinolone exposure can worsen the disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Gastrointestinal surgery: antibiotic-associated colitis treatment?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.