Clostridioides difficile (C. diff) infection
Clostridioides difficile — formerly called Clostridium difficile and shortened in conversation to C.
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Medicines commonly prescribed for Clostridioides difficile (C. diff) infection
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 40 mg/mlActive substance: fidaxomicinManufacturer: Tillotts Pharma GmbhPrescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 250 mgActive substance: saccharomyces boulardiiManufacturer: BiocodexPrescription not requiredDosage form: TABLET, 200 mg fidaxomicinActive substance: fidaxomicinManufacturer: Tillotts Pharma GmbhPrescription required
Clostridioides difficile — formerly called Clostridium difficile and shortened in conversation to C. diff — is a bacterium that lives quietly in the gut of a good number of healthy people, held in check by everything else growing there. Upset that balance, most often with a course of antibiotics, and the bacterium multiplies, starts producing toxins and damages the lining of the large bowel. The result is diarrhoea that will not settle on its own and that is treated, oddly enough, with another antibiotic. The illness ranges from mild to life-threatening, so the thing that matters most is noticing when it has stopped being an ordinary upset stomach.
Why medicine for an infection causes an infection
An antibiotic does not choose its targets: along with the germ causing the illness it wipes out the useful residents of the gut. The empty space is taken by whatever is not sensitive to that antibiotic — and C. diff fits perfectly. Its spores survive medicines, drying out and ordinary detergents; once the competition is gone the spores germinate, the bacterium multiplies and releases two toxins that eat into the inner lining of the colon.
The riskiest antibiotics in this respect are clindamycin, fluoroquinolones, cephalosporins and broad-spectrum penicillins, but almost any antibiotic can set it off, including a single dose given before an operation. One detail matters a great deal: timing. The diarrhoea may begin on day three of the course, or two months after the last tablet was swallowed, by which point nobody thinks to make the connection. If your bowels are upset after recent antibiotic treatment, tell the doctor, even if the course was a while ago and for something unrelated.
What it looks like
- watery, loose stools three or more times a day, going on for longer than a day;
- a characteristically unpleasant smell, sometimes mucus in the stool;
- cramping pain and spasms in the abdomen;
- fever;
- nausea and loss of appetite;
- weakness and dehydration — a dry mouth, passing little urine, dizziness on standing.
There is usually no blood in the stool; if blood appears, that is already a reason to seek help urgently.
Who gets it more often
- people over 65;
- anyone taking antibiotics now or who finished a course in the last two to three months;
- anyone in hospital for a long stay or living in a care home;
- people with a weakened immune system — from chemotherapy, serious chronic illness, diabetes, kidney failure;
- those on long-term acid-reducing medication from the proton pump inhibitor group;
- anyone who has had this infection before: one in five gets it again.
Transmission happens most often in hospitals and care facilities, but it happens at home as well. Spores leave the body in the stool, settle on door handles, the toilet, bed linen and bed rails, survive there for weeks, and are then carried to the mouth on hands.
When it stops being just diarrhoea
In some people the inflammation takes over the whole large bowel, its wall balloons out and stops contracting. This is severe disease, and it has to be recognised quickly.
- severe pain spread across the abdomen, with the belly distended and tense;
- the diarrhoea has suddenly stopped while the pain has got worse — a deceptively reassuring sign that is in fact one of the most alarming;
- blood in the stool;
- a high fever with chills;
- vomiting, or being unable to keep fluids down;
- confusion, sudden weakness, passing very little urine, a racing pulse.
Any of these means seeking emergency care within the hour rather than waiting for an appointment. Behind them lies a grossly dilated bowel, perforation and blood poisoning; treatment then takes place in hospital, sometimes with a surgeon involved.
How the diagnosis is confirmed
A stool test is needed, looking for the bacterium's toxins and for the organism itself. The subtlety is that only loose stool is tested: C. diff can be found in formed stool in a perfectly healthy carrier, and that person needs no treatment. For the same reason there is no point repeating the test after recovery "to be sure" — the bacterium can still show up long afterwards, which means nothing and does not call for another course. In severe illness, blood tests are added along with an X-ray or a scan of the abdomen to assess the state of the bowel.
How it is treated
The first step is to stop the antibiotic that started it all, where possible, or swap it for a lower-risk one. Then comes a medicine that acts specifically on C. diff; these are taken by mouth, because they need to work inside the bowel rather than in the bloodstream. A standard course runs about ten days. People usually feel better within a few days, but full recovery takes one to two weeks.
Finishing the whole course matters even if the stools returned to normal on day three: treatment abandoned halfway brings the illness back. Alongside it, drink plenty — water and rehydration solutions that replace lost fluid and salts.
What you must not do is take anything that stops diarrhoea, such as loperamide. Those medicines lock the toxins inside the bowel and can turn a moderate infection into a severe one. If the diarrhoea returns after the course or the person deteriorates sharply, treatment is repeated on a different regimen, sometimes in hospital. After a third or subsequent relapse, a faecal microbiota transplant may be offered: gut flora from a healthy donor is transferred into the bowel to crowd the bacterium out. The method sounds strange, but for stubborn relapses it works better than yet another course of antibiotics.
How to avoid passing it on at home
- wash your hands with soap under running water, especially after the toilet and before eating;
- do not rely on alcohol hand gel: alcohol does not kill the spores, it only spreads them around;
- clean the toilet, handles, taps and light switches with a chlorine-based product after every use;
- wash soiled linen and clothing separately, at the hottest temperature the fabric will take;
- do not share towels or flannels — give the person their own;
- stay at home for at least 48 hours after the stools return to normal, and do not prepare food for others during that time.
And more broadly: do not ask for an antibiotic for a cold, and do not finish off leftover packets from last time. Every unnecessary course is one more opening for C. diff.
Online consultation
During an online appointment the doctor will check which antibiotics you took and when, what the stools look like and how often they come, whether there are signs of dehydration and how severe the picture is. By the end it will be clear whether a stool test is needed, whether this can be treated at home, and which medicines should be stopped. The doctor will also go through the warning signs that mean going straight to hospital, so that you know what to watch for.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Clostridioides difficile (C. diff) infection with a doctor online.
