C Diff - Dad in Hospital

My dad is in the hospital for c diff and he was in a previous hospital for a couple of days until we transferred him to another hospital where he has been there for about 5 days now. They say is colon is enlarged to a 9 and that if it goes to a 12 then they would need surgery. They have him on all the c diff antibotics. My question is how long does it take for these antibiotics to kick in? Is a colon of a 9 that bad? He is staying stable. He has been in there 5 days and they do an x ray everyday and they say its still a 9. They said he is getting very slowly better. But also, I read that this surgery is rare and what are the chances of him getting it. The colon doctor scared him yesterday saying well if one thing gets worse like his white blood count going up (which was 19,000, now it went down to 17,000) or the xray showing a more enlarged colon than we'll have to do surgery. When we you recommend surgery in this case? I almost think they are not giving him a chance. He is 75 and was in great health before he got this. He colits that turn into c diff from a anti biotic that they gave him for a dental procedure. Is there anything else they could be doing? They said his kidneys are getting better and when he went in they were failing.

[Kevin Pho, MD]

I can't give personal recommendations without evaluation.

Also, I'm not sure what is meant by a "9" versus a "12."  Are the doctors talking about the degree of dilation?  

Indeed, there are difficult causes of C difficle colitis, and a variety of antibiotic regimens that can be tried.  Surgery would be the last resort, to be reserved only if the antibiotics fail.

Studies show that cases where the patient is greater than age 65, has a WBC above 20,000 and a plasma lactate level between 2.2 and 4.9, are candidates for surgery.  

So, it appears that the WBC is approaching that level.  I would obtain a plasma lactate level to help determine the need for surgery,  

More experimental therapy, such as intravenous immunoglobulins, can also be tried in cases of antibiotic failure.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

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Twitter.com/kevinmd