Clostridium difficile

Symptoms of a C. difficile infection 

C. difficile infections are unpleasant and can sometimes cause serious bowel problems.

Symptoms of a C. difficile infection usually develop when you're taking antibiotics, or when you've finished taking them within the last few weeks.

The most common symptoms are:

• watery diarrhoea, which can be bloody
• painful tummy cramps
• feeling sick
• signs of dehydration, such as a dry mouth, headaches and peeing less often than normal
• a high temperature (fever) of above 38C (100.4F)
• loss of appetite and weight loss

In some cases, serious complications can develop, such as damage to the bowel or severe dehydration. This may cause drowsiness, confusion, a rapid heart rate and fainting.

People most at risk of C. difficile

C. difficile mostly affects people who:

• have been treated with broad-spectrum antibiotics (antibiotics that work against several types of bacteria) or several different antibiotics at the same time, or those taking long-term antibiotics
• have had to stay in a healthcare setting, such as a hospital or care home, for a long time
• are over 65 years old
• have certain underlying conditions, including inflammatory bowel disease (IBD), cancer or kidney disease
• have a weakened immune system, which can be because of a condition such as diabetes or a side effect of a treatment such as chemotherapy or steroid medication
• are taking medication to reduce the amount of stomach acid they produce
• have had surgery on their digestive system

Many C. difficile infections used to occur in places where many people take antibiotics and are in close contact with each other, such as hospitals and care homes.

Strict infection control measures have helped to reduce this risk. An increasing number of C. difficile infections now occur outside these settings.

When to get medical advice 

Visiting your GP surgery with a possible C. difficile infection can put others at risk. It's best to call your GP or GP out of hours service if you're concerned or feel you need advice.

Get medical advice if:

• you have persistent diarrhoea after finishing a course of antibiotics
• you have bloody diarrhoea
• you have diarrhoea and experience severe tummy pain, a high fever, a rapid heart rate or fainting
• you have symptoms of severe dehydration, such as confusion, drowsiness, only passing small amounts of urine or no urine at all

Diarrhoea can be caused by a number of conditions. It is a common side effect of antibiotics. If you have diarrhoea while taking antibiotics, it doesn't necessarily mean you have a C. difficile infection.

Your GP may suggest sending off a sample of your poo to confirm whether you have C. difficile.

Treatment for C. difficile 

Your GP will decide whether you need hospital treatment (if you're not already in hospital). If the infection is mild, you may be treated at home.

If you're in hospital, you might be moved to a room of your own during treatment. This is to reduce the risk of the infection spreading to others.

Your GP or hospital doctor will stop any medication that may have caused the infection.

Following testing, C. difficile may be treated with an antibiotic, if necessary. Most people usually make a full recovery in a week or two.

However, the symptoms come back in around one in five cases and treatment may need to be repeated.

Looking after yourself at home 

If you're well enough to be treated at home, the following measures can help relieve your symptoms and prevent the infection spreading:

• make sure you finish the entire course of any antibiotics you're prescribed, even if you're feeling better
• drink plenty of fluids to avoid dehydration and eat plain foods such as soup, rice, pasta and bread if you feel hungry
• take paracetamol  for tummy pain or a fever
• don't take anti-diarrhoeal medication, as this can stop the infection being cleared from your body
• regularly wash your hands and contaminated surfaces, objects or sheets 
• stay at home until at least 48 hours after your last episode of diarrhoea

Your GP may contact you regularly to make sure you're getting better. Call them if your symptoms return after treatment finishes, as it may need to be repeated.

How you get C. difficile 

C. difficile bacteria are found in the digestive system of healthy adults, and children, without any symptoms of infection.

Some antibiotics can interfere with the natural balance of bacteria in the bowel, and cause diarrhoea.

When this happens, some types of C. difficile, (which produce toxins  causing illness) can spread to other people.

C. difficile can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless they're thoroughly cleaned. It can infect someone else if they get the bacteria into their mouth.

Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.

The person will continue to be infectious whilst they still have symptoms. They should stay away from work or school until they have been free from diarrhoea for 48 hours.

How to stop C. difficile spreading 

C. difficile infections can be passed on very easily. You can reduce your risk of picking it up or spreading it by practising good hygiene, both at home and in healthcare settings.

The following can help:

• stay at home until at least 48 hours after your symptoms have cleared up
• wash your hands regularly with soap and water, particularly after going to the toilet and before eating – use liquid rather than bar soap and don't use flannels or nail brushes
• clean contaminated surfaces – such as the toilet, flush handle, light switches and door handles – with a bleach-based cleaner after each use
• cleaning effectively in the kitchen
• don't share towels and flannels
• wash contaminated clothes and sheets separately from other washing at the highest possible temperature
• when visiting someone in hospital, follow visiting guidelines, avoid taking any children under the age of 12, and wash your hands with liquid soap and water when entering and leaving ward areas – don't rely on alcohol hand gels alone, as they're not effective against C. difficile, (but can prevent other infections)
• avoid visiting hospital if you're feeling unwell or have recently had diarrhoea

More useful links

• How to use your health service
• C.difficile infection leaflet – Public Health Agency website
• Hand hygiene leaflet – Public Health Agency website