Complaints & connections · borters.ch
Clostridioides difficile
A germ that takes over after antibiotics — which is why careful antibiotic use is also prevention.
Also known as: C. difficile · C. diff infection · antibiotic-associated colitis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A gut infection that occurs mainly after antibiotic treatment: the antibiotics disturb the protective gut flora, allowing the bacterium Clostridioides difficile to spread and produce a toxin that inflames the colon. Typical signs are watery diarrhoea, abdominal cramps and fever. More often affected are older people or those recently treated in hospital. Reassuringly: not every bout of diarrhoea after antibiotics is a C. difficile infection — but severe or persistent diarrhoea should be assessed. Treatment is targeted and, in stubborn cases, can extend to a stool transplant that restores a healthy gut flora.
For severe or persistent diarrhoea after antibiotics, arrange a stool test for C. difficile.
Where possible, the triggering antibiotic is adjusted or stopped by the doctor.
There are antibiotics specifically effective against C. difficile; treatment belongs in medical hands.
For recurrent infections, transferring a healthy gut flora can be very effective.
The spores are contagious — thorough hand-washing with soap protects those around.
Vancomycin and fidaxomicin as tablets stay in the gut and act exactly there — unlike the usual antibiotic, which let the organism take over in the first place. In about one in five it returns within eight weeks, because the flora is not back yet. Stool transplant targets precisely that and prevents relapse in around nine out of ten people — one of the few examples where a flora beats a drug.
The risk rises above all in the first three months after a course of antibiotics and is highest in the first month. The diarrhoea usually begins a few days after the triggering antibiotic starts, but can appear up to ten weeks later. After the first treatment it returns in about one in five within eight weeks; after a first relapse in about forty in a hundred. The spores survive on surfaces for months and are insensitive to hand disinfectant — here washing is what works.
Often during or in the weeks after a course of antibiotics.
Alongside frequent, watery stools.
Risk rises with age, hospital stays and multiple antibiotics.
Strongly raised white cells are a warning sign here of a severe course and a reason not to wait.
A rise shows the loss of fluid and is among the signs that decide on treatment in hospital.
A low albumin speaks for a severe, longer-lasting course with loss of protein through the inflamed bowel.
Together with fever and abdominal pain it places the severity — the diagnosis comes from the detection in the stool.
Soluble fibres like psyllium and oats bind water and make the stool supple. Wheat bran and a lot of raw vegetables, by contrast, increase bloating and pain in a sensitive gut — this distinction explains most of the failures.
Taken up right at the end of the small bowel and needing a helper from the stomach. If either place is affected a deficiency arises — often only after years, because the liver holds a store.
Fibre without water makes the stool harder instead of softer. The two belong together, and the effect only sets in after some days.
Taken up in the upper small bowel and needing stomach acid. Acid blockers, an inflamed lining and silent blood losses often come together here.
Draws water into the bowel and therefore works with a sluggish stool. The belly shows the upper limit: if the stool gets too loose, the dose at once was too high.
Best studied for prevention during antibiotic treatment. It does not treat an established infection, and it is advised against with severely weakened immunity — cases of blood poisoning are described.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Acid blockers lower the stomach acid that otherwise kills part of the spores. On standing use the risk is measurably raised — one of the reasons these medicines should not run on indefinitely.
The loss of fluid and salt is the most dangerous part here, not the bacteria themselves. Potassium and sodium belong measured, especially in older people and on water tablets.
With heavy diarrhoea potassium and sodium go too. Oral rehydration replaces both; plain water alone does not cover the loss.
After the acute phase well-tolerated cooked food comes first, then fibre step by step over 2–4 weeks.
For prevention during antibiotic treatment the evidence is strongest — reviews find fewer cases. For treating an established infection they are no substitute; with severely weakened immunity they are advised against.