22nd July 2023

A 67-year-old woman presents to an urgent care centre with a 1-week history of loose malodorous stool

A 67-year-old woman presents to an urgent care centre with a 1-week history of loose malodorous stool, with 6 bowel motions a day. Her usual bowel habit is once every other day. This is associated with intermittent mild lower abdominal pain. She has a history of recurrent urinary tract infections, the most recent of which was 4 weeks ago, when she took a 7-day course of oral ciprofloxacin. She takes no regular medications and has no known drug allergies. Her abdomen is generally tender on deep palpation with very active bowel sounds but no rebound tenderness. Her observations are within normal limits and she is afebrile. Her white cell count is mildly raised at 12 x10⁹/L and her CRP is 47 mg/L. Her renal function is normal. Stool samples are collected and she is discharged with safety netting. 2 days later, the patient’s GP is contacted as her stool PCR for Clostridium difficile toxin is positive.

What is the most appropriate first line treatment for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.