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Q5. If C. diff is strongly suspected it is reasonable to initiate oral metronidazole while awaiting confirmation of c.diff.
oral is preferred but IV is given if necessary in early disease. Switch back to oral as soon as possible as inflammation resolves.

Q6. Review all of the antibacterials after confirmation of c.diff & remove all those not recommended for the treatment of c.diff.

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Q1 Appropriate cultures (eg urine, bloods) should have been requested before starting to give antibacterials. Blood pressure should be checked
Other tests such as white bllod count, neutrophilis, erythorcyte, sedimentation rate & platelets

Q2, Until cultures are available acute sepsis of an unknown origin would require a broad spectrum cover of both g negative & g positive for micro organism
suggest
Timentin, Tazocin plus aminoglycoside
vancomycin plus fluuoroquinolone plus metronidazole
NB all broad spectrum will increase risk of c.diff

Q3. Doreen is taking Paracetamol & Prednisolone.
Paracetamol may mask pyrexia associated with infection.
Prednisolone masks signs of infection

Q4. Switch to IV hydrocortisone
Renal function should be investigated, particularly potassium levels
Also check past recordds of creatine & urea to ensure whether this is acute or chronic renal failure induced by infection
Monitor & adjust drug doses according.
Monitor creatine, urea & electrolytes levels daily
She will also need thrombopropylaxis & IV fluids

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Q6 - Only use IV if patient cannot take orally

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Q6 - Only use IV if patient cannot take orally

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Q5 - no, as no confirmation of infection

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Q5 - no, as no confirmation of infection

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Q3 - concomitant use of steroids might mask symptoms

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Q5 - no confirm culture of sample and gram stain

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Q5 - no confirm culture of sample and gram stain

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Potassium needs looking at - bloods to be repeated. Creatinine and Urea are both high - what did she receive whilst in hospital for surgery

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Pt history
allergies
What gram stain it is

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1. What other biochemicals or microbiological tests should have been undertaken and when?

2. The medical team believe Doreen may have an infection and want to start antibacterials. Make a note of the factors you would take into consideration to help you select an appropriate antibacterial regime.

3. Why might her temperature be normal in the presence of sepsis?

4. Apart from the rationalising her antibacterial therapy; identify two other medicines optimising issues which need addressing urgently. Suggest monitoring parameters for these issues.

5. Is it appropriate to prescribe metronidazole for Clostridium difficile at this point?

6. Would you recommend the use of IV metronidazole for this indication.