PANCE Exam Practice Questions: Quiz 368

A 70-year-old nursing home resident was admitted to the hospital for pneumonia and treated for 10 days with levofloxacin. On discharge she was improved but developed diarrhea one week later. She had low-grade fever and mild abdominal pain with 2 to 3 watery, nonbloody stools per day. A cell culture cytotoxicity test for Clostridium difficile–associated disease was positive. The patient was treated with oral metronidazole, but did not improve, even after 10 days. Diarrhea has increased and fever and abdominal pain continue. What is the best next step in the management of this patient?
- a. Obtain C difficile enzyme immunoassay.
- b. Continue metronidazole for at least two more weeks.
- c. Switch treatment to oral vancomycin.
- d. Hospitalize patient for fulminant C difficile–associated disease.

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