Our last article covered the signs, symptoms and treatment of IBD which affects many people across the world. In keeping with conditions of the bowel and colon, we’d like to discuss Clostridium difficile, also known as C. difficile along with the signs, symptoms and treatment options.
What Is C. Difficile?
C. difficile or C. diff is a bacteria that causes severe diarrhoea and colitis which refers to inflammation of the colon. This infection is common among people who were recently treated with antibiotics but it can easily spread to others. Clostridium difficile infections are particularly unpleasant and can cause serious bowel problems but doctors usually treat it with another course of antibiotics.
How Do You Get A C. Difficile Infection?
C. difficile is all around us from the air and water to soil, and in faeces (humans and animals). When the bacteria are outside the body, they turn into spores that can survive on surfaces for weeks and even months.
These spores are not “active” but they can after you swallow them and they enter your intestines. While some people have the bacteria in their intestines without any symptoms, others are not so lucky and the bacteria create toxins that attack the intestines.
C. diff is on the list of hospital-acquired infections as you can get C. difficile when staying in a healthcare facility whether it’s a hospital or care home for a long time. Symptoms of a C. diff infection often develop when taking antibiotics or recently finished a course within the last few weeks.
Recommended: The Importance Of Becoming An Antibiotic Guardian
Symptoms Of Clostridium Difficile
If you have taken antibiotics recently and have any of the following C. difficile symptoms, seek advice from a healthcare professional.
- diarrhoea several times a day
- a high temperature (fever)
- loss of appetite
- feeling sick
- tummy pain
- rapid heart rate
- dehydration in some cases
Who Is At Risk Of Contracting A Clostridium Difficile (C. diff) Infection?
As mentioned in the previous section, C. diff mostly affects people who have been taking antibiotics or have spent time in a hospital or care home. However, for the sake of accuracy, here is a more detailed breakdown of who is most at risk:
- Taking broad-spectrum antibiotics, several different antibiotics at the same time or taking long-term antibiotics
- An extended stay in a hospital or care home
- People older than 65 years
- Anyone with certain underlying conditions, including inflammatory bowel disease (IBD), cancer or kidney disease
- People with a weakened immune system caused by diabetes or as a side effect of treatment like chemotherapy or steroid medication
- Taking medication called a proton pump inhibitor (PPI) to reduce the amount of stomach acid they produce
- Have had surgery on their digestive system
Is A C. Diff Infection Dangerous?
If you have a severe C. difficile infection, you are likely experiencing diarrhoea 10 or more times per day. It can also result in severe intestinal inflammation and an enlarged colon. In some severe cases, you could develop an extreme response to an infection called sepsis. All of these conditions or symptoms are serious and you could end up in the hospital. Remember, if your diarrhoea from C. diff is extremely severe, seek medical help immediately as it can result in life-threatening dehydration.
Treatment Options For Clostridium Difficile Infections
For the first episode of mild, moderate or severe C. difficile infection, prescribe Vancomycin with an oral dose for 10 days. If Vancomycin is ineffective, recommend Fidaxomicin orally twice a day for 10 days as a second-line antibiotic for the first episode of mild, moderate or severe C. difficile infection.
If first- and second-line antibiotics are ineffective, seek specialist advice. Some may initially offer Vancomycin up to 500 mg orally four times a day for 10 days with or without Metronidazole (500 mg intravenously three times a day for 10 days).
When someone has a relapse within 12 weeks of symptom resolution, another dose of Fidaxomicin (200 mg orally twice a day for 10 days). If there’s a recurrence after 12 weeks, treatment is either 125 mg Vancomycin four times a day for 10 days or 200 mg Fidaxomicin twice a day for 10 days.
Treatment For Severe Cases
For life-threatening C. difficile infections, patients should seek urgent specialist advice, which may even include surgery. Antibiotics a specialist could initially offer are either Vancomycin (500 mg orally four times a day for 10 days) with Metronidazole (500 mg intravenously three times a day for 10 days)
When referring a patient with a severe C difficile infection, they need care from a multidisciplinary team that may include the following people:
- Infectious diseases specialist
When prescribing antibiotics for possible or confirmed C. difficile infections in adults, be sure to consult this table from NICE.org.
For children and young people under 18 years, base the choice of antibiotic on the recommendation for C. difficile infection in adults. Take into account licensed indications and what products are available by finding out more information on BNF for Children.
Preventing C. Difficile
The only way to prevent C. difficile infections is through good antimicrobial stewardship, infection control and environmental hygiene measures. You can find detailed information from PHE and NICE’s guidelines on healthcare-associated infections and antimicrobial stewardship.
A patient’s diagnosis of C. difficile infection should always be recorded, especially when they transfer from one hospital care setting to another. This will help doctors prescribe the right antibiotics in the future to ensure the best possible treatment.
Also, do not offer patients antibiotics to prevent C. difficile infection and never advise people taking antibiotics to take prebiotics or probiotics to prevent C. diff.
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