Clostridioides difficile (C. diff) infection: symptoms, treatment and preventing spread

The NHS says Clostridioides difficile (also called Clostridium difficile, C. difficile or C. diff) is a type of bacteria that can cause diarrhoea and often affects people who have been taking antibiotics. It usually lives harmlessly in the bowel with many other bacteria, but when you take antibiotics the balance of bacteria can change, causing an infection.

The NHS adds that when someone has a C. diff infection it can spread to others very easily if bacteria in the person's stool get onto objects and surfaces.

The NHS lists the common symptoms as diarrhoea, a high temperature, loss of appetite, feeling sick and a stomach ache.

• The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have diarrhoea and are taking, or have recently taken, antibiotics.

• It also advises urgent help for bloody diarrhoea or bleeding from the bottom, or diarrhoea lasting more than 7 days.

The NHS says you are more likely to get a C. diff infection if:

• you are over 65

• you are taking, or have recently taken, antibiotics

• you are staying in hospital or a care home for a long time

• you have a weakened immune system, for example from diabetes or kidney failure or from treatment like chemotherapy

• you take a proton pump inhibitor (PPI), such as omeprazole, or other medicines that reduce stomach acid

• you have had a C. diff infection in the past

The NHS says that if a doctor thinks you have a C. diff infection they may ask for a stool sample to be tested. The infection can sometimes be treated at home, or you might need hospital care, because it can sometimes lead to more serious problems like sepsis.

NICE advises assessing whether this is a first or further episode, how severe it is, and individual factors such as age, frailty and other conditions. It also advises reviewing existing antibiotics, and stopping them unless essential, and reviewing the need for proton pump inhibitors, laxatives and medicines that can cause problems if you are dehydrated, such as NSAIDs, ACE inhibitors, angiotensin-2 receptor antagonists and diuretics. These are decisions for the treating clinician, not something to change yourself.

The NHS says treatment is stopping any antibiotics you are already taking if possible and taking a new 10-day course of another antibiotic that can treat C. diff, together with advice to avoid dehydration, such as drinking plenty of water. Symptoms should improve a few days after starting, but it may be 1 to 2 weeks before the infection clears completely. Keep taking the course until the end even if you feel better, as symptoms could come back if you stop early.

NICE advises offering an oral antibiotic to adults with suspected or confirmed infection, and for children and young people starting treatment with, or after advice from, a microbiologist, paediatric infectious diseases specialist or paediatric gastroenterologist. It advises managing fluid loss and symptoms as for acute gastroenteritis and not offering antimotility medicines such as loperamide. The NHS likewise says not to take medicine to stop diarrhoea, such as loperamide, because it can prevent the infection clearing.

The NHS says to go back to the GP if symptoms get worse, you feel very unwell after starting the antibiotics, or symptoms return afterwards, in which case treatment may need to be repeated or hospital care may be needed. If the infection comes back 2 or more times, you may be offered a faecal microbiota transplant, where bacteria from a healthy person's stool are put into your gut to help stop the infection. NICE advises considering faecal microbiota transplant for adults with a recurrent episode who have had 2 or more previous episodes.

The NHS suggests:

• stay at home until at least 48 hours after the diarrhoea stops

• wash hands regularly with soap and water

• clean the toilet and the area around it with disinfectant after each use

• wash clothes and sheets with stool on them separately from other washing at the highest possible temperature

• do not share towels and flannels

• do not rely on hand sanitiser, as it does not kill or remove C. diff