# A client recently treated with clindamycin develops profuse watery diarrhea, abdominal cramping, and fever. The family asks if the client can take loperamide for symptom relief. Which is the nurse's best response?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391815&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A client recently treated with clindamycin develops profuse watery diarrhea, abdominal cramping, and fever. The family asks if the client can take loperamide for symptom relief. Which is the nurse's best response?

## Option

1. "Loperamide is safe to use to slow diarrhea."
2. "Loperamide should be avoided when C. difficile infection is suspected because it can worsen toxin retention and cause toxic megacolon. Treatment requires oral vancomycin or fidaxomicin." **✔ Correct answer**
3. "Use loperamide every 4 hours for fastest results."
4. "Combine loperamide with diphenoxylate for stronger effect."

**Correct answer: 2**

## Explanation

Correct (2): Antimotility agents (loperamide, diphenoxylate) are contraindicated in suspected/confirmed C. difficile infection, severe inflammatory bowel disease, and bacterial enteritis with fever — they retain toxins/bacteria and risk toxic megacolon. CDI treatment: oral vancomycin or fidaxomicin (replaces metronidazole as first-line per current IDSA). (1,3,4) Dangerous.

## In-depth explanation

Memory Tip Loperamide = "STOP gut motility = STOP toxins inside." Avoid in CDI, severe IBD, dysentery with fever. Also QT prolongation in overdose.

## Clinical scenario

Scenario 70-year-old female 2 weeks after clindamycin for dental infection presents with profuse watery diarrhea, cramping, fever 38.3°C. C. difficile assay pending.

## Key concepts

- **Loperamide** — Mu-opioid agonist on gut; antidiarrheal; avoided in invasive bacterial/CDI.
- **Clostridioides difficile infection** — Antibiotic-associated colitis; treat with oral vancomycin or fidaxomicin; avoid antimotility agents.
- **Toxic megacolon** — Massive dilation of colon with sepsis; loperamide and antimotility agents are precipitants.

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