American Board of Family Medicine (ABFM) Practice Exam

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Which antibiotic is typically NOT used for the treatment of severe C. difficile infections?

  1. Oral vancomycin

  2. Intravenous metronidazole

  3. Oral fidaxomicin

  4. Intravenous clindamycin

The correct answer is: Intravenous clindamycin

The primary concern when treating severe Clostridioides difficile infections is to select antibiotics that effectively target the pathogen while minimizing further risks or complications. Oral vancomycin is a first-line treatment for C. difficile, particularly in severe cases, because it concentrates in the gut where the infection occurs. Similarly, oral fidaxomicin is specifically indicated for C. difficile infections due to its efficacy and minimal systemic absorption. Although metronidazole was historically used, current guidelines favor oral vancomycin or fidaxomicin for moderate to severe cases due to concerns about efficacy. On the other hand, intravenous clindamycin is not used for treating C. difficile infections. In fact, clindamycin is known to be one of the antibiotics that can actually predispose patients to C. difficile infections, as it affects the normal gut flora, allowing C. difficile to proliferate. Therefore, it is not an appropriate choice for treatment once a patient has developed such an infection. The focus remains on antibiotics that effectively target C. difficile without exacerbating the situation or contributing to further risk.