Patient Case: Cystitis with History of c.difficile
A 25 year old 
presents to clinic with frequent 
urination and is diagnosed with cystitis. She has a history of C. difficile. Which 
option is lowest risk for C. difficile 
recurrence?
A) Cefdinir
B) Ciprofloxacin
C) Nitrofurantoin
How did others respond?
Reveal the answer
Best Answer
Nitrofurantoin causes minimal damage to the GI flora and has been shown in studies to be low risk for C. difficile.
Explanation: FQs take the prize in some studies as the highest risk antibiotic for C. difficile. Their broad Gram negative spectrum causes collateral damage to the GI flora. 3rd generation cephalosporins like cefdinir and ceftriaxone and 4th generation agents like cefepime are also high risk. 1st generation agents like cephalexin and cefazolin are relatively low risk.
All antibiotics come with some risk of C. difficile but it’s important to minimize risk when we can to protect patients from superinfection 