A 73-year-old patient with a respiratory infection due to Pseudomonas aeruginosa treated with Amikacin + Ceftazidima presented with fever associated with diarrheal stools.
Empirical treatment with metronidazole was initiated and the detection of C. difficile toxin in stool was positive.
He was diagnosed with severe and complicated ICD according to the criteria mentioned above and was referred to the resuscitation unit.
The patient was febrile (axillary temperature > 38.5ยบ C), with hypoalbuminemia (serum albumin < 3 g/dL), abdominal discharge equation, Crs around 0.6 110 mg/dL (clarification).
The radiological study by computed tomography showed compatible findings with pancolitis.
This, in addition to the positive detection of C. difficile toxin, confirms the diagnosis of pseudomelanoma pancolitis and it is decided to modify the treatment.
Oral vancomycin is administered at doses of 250 mg every 6 hours for 2 days.
After this treatment, the patient improves by decreasing abdominal discomfort and changing the dose to 125 mg every 6 hours for another 13 days.
After 7 days of treatment plasma trough values of 10.25 μg/mL were reached.
Treatment is continued for a total of 15 days.
Three days after discharge, the patient was admitted again for C. difficile reinfection. Oral vancomycin was started on a descending regimen starting at 125 mg every 6 h.
After 7 days plasma concentrations were 5.94 μg/mL.
After 14 days concentrations decreased to 2.65 μg/mL.
The descending pattern was continued until concentrations were < 0.70 μg/mL with 125 mg every 24h.
It is continued with 125 mg every 48 h, ending with 125 mg every 72 h.
One week after the descending course, the patient was readmitted with a third reinfection.
It was treated with 11 days of vancomycin 125 mg every 6 h until treatment with fidaxomicin 200 mg every 12 h was started.
