139.2 📚 國考版

139.2.0.1 必背 — 2021 IDSA Update

• Initial episode (any severity): Fidaxomicin first-line (preferred over vanco)
• Vancomycin PO = strong alternative
• Metronidazole = NO LONGER first-line (only fulminant adjunct or resource-limited)

139.2.0.2 必背 — Severity Cut-offs

• Severe: WBC ≥ 15K OR Cr > 1.5x baseline (or > 1.5 mg/dL)
• Fulminant: severe + ileus / hypotension / megacolon

139.2.0.3 必背 — Recurrence Tx

• First recurrence: fidaxomicin (or vanco taper) + 考慮 bezlotoxumab
• Multiple recurrences: FMT (85%+ cure)
• 新 oral biotic products: Rebyota (rectal), Vowst (oral capsule)

139.2.0.4 易混淆

• Asymptomatic colonization: 不 treat (20% inpatient carriers)
• Loperamide in CDI: avoid (toxic megacolon risk)
• Empirical Vanco IV: 對 GI CDI 無效 (need PO/PR)

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