AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationHard
A 70-year-old female with a history of recurrent Clostridium difficile infection (CDI) is discharged from the hospital after successful treatment. She is now at high risk for recurrence. What is the most appropriate preventative measure to include in her discharge plan?
- AProphylactic oral vancomycin for 10 days.
- BStrict adherence to hand hygiene with alcohol-based sanitizers.
- CExtended pulsed or tapered oral vancomycin regimen.
- DDaily probiotic supplementation.
Show answer & explanationAnswer & explanation
Correct answer: C. Extended pulsed or tapered oral vancomycin regimen.
For patients with recurrent CDI, an extended pulsed or tapered oral vancomycin regimen is the most effective strategy to prevent further recurrences after successful treatment of the acute episode.
Why the other options are wrong
- A. Prophylactic oral vancomycin for a short duration is not as effective as a pulsed or tapered regimen for recurrent CDI prevention.
- B. While important, strict hand hygiene alone is insufficient to prevent recurrence in high-risk individuals and is a general infection control measure.
- D. The evidence for daily probiotic supplementation in preventing CDI recurrence is mixed and not as strong as for specific antibiotic regimens.
Recurrent CDI Prevention
After successful treatment of Clostridium difficile infection, high-risk patients (e.g., with multiple recurrences) benefit most from a prolonged, tapered, or pulsed oral vancomycin regimen to prevent further episodes.
- Recurrence is common, especially after 3+ episodes.
- Oral vancomycin or fidaxomicin are used for treatment and prevention.
- Fecal microbiota transplantation (FMT) is another option for refractory recurrent CDI.
Memory trick: After C. diff, don't just stop; taper the treatment to keep it gone.