Antibiotics and C. diff

Antibiotics and C. diff

Cases of Clostridioides difficile (C. diff) have increased significantly in the last five years, and a lot of the responsibility for this lies with us – or at least those of us who overuse antibiotics.

C. diff is a bacterium that lives naturally in the gut of some people without causing any problems, but it can multiply rapidly and produce toxins once the balance of “good” bacteria in the bowel is disrupted.

So you are most likely to get an infection during or just after a course of antibiotics, which do not discriminate about the bacteria they destroy.
 

People don’t make the connection

Dr Godwa, clinical research leader at Trialmed, says most people don’t connect their own antibiotic use with the wider picture.

“People hear about C. diff outbreaks and assume it is about dirty hospitals, but the evidence tells a different story. Antibiotic use, not environmental cleanliness, is the single biggest driver of who develops this infection.”

Symptoms of C. diff infection

When C. diff overwhelms the beneficial bacteria in the bowel, it can cause symptoms such as diarrhoea, fever and stomach cramps, and in more severe cases can lead to inflammation of the colon.

Dr Godwa warns that every course of antibiotics, particularly broad-spectrum ones, wipes out protective gut bacteria and gives C. diff room to take hold.
 

Who is most at risk?

Anyone currently taking or recently finished antibiotics

People are up to ten times more likely to develop C. diff while on antibiotics and during the month after finishing a course, with longer courses further increasing the risk. This is because antibiotics do not just kill the bacteria causing the illness they are prescribed for, they also wipe out large sections of the healthy gut microbiome that normally competes with C. diff for space and nutrients, leaving the bowel with far less natural resistance.

Certain antibiotics carry a particularly high risk, including clindamycin, cephalosporins, fluoroquinolones such as ciprofloxacin, and broad-spectrum penicillins, all of which can cause extensive disruption to gut bacteria.

If you are already on antibiotics, speak to a doctor if you develop diarrhoea or feel very unwell while taking them, so they can decide whether to adjust treatment or investigate for C. diff.

People aged over 65

Older adults account for the vast majority of cases, with more than 80% of infections reported in the over-65 age group. This is largely down to a combination of weaker immune defences, more frequent antibiotic exposure through repeat courses for other infections, and greater contact with healthcare settings, all of which can increase the risk of C. diff taking hold.

People with weakened immune systems

Those with cancer, organ transplants, or taking immunosuppressant drugs are significantly more vulnerable to infection taking hold.

A properly functioning immune system helps limit how much C. diff can multiply and how severe the resulting inflammation becomes, so when that response is suppressed by illness or medication, infections tend to progress further and recovery takes longer.

Anyone with a previous C. diff infection

Prior infection raises the risk of recurrence, with relapse occurring in around 20 to 30% of patients, and that risk climbs to 40 to 60% after a first recurrence.

“Recurrence happens for two main reasons: dormant spores left behind in the gut after the first infection can germinate again once conditions allow, or a person can be reinfected from a contaminated environment, and in most documented cases it is the original strain relapsing rather than a fresh infection.

What people can do differently?

Dr Godwa advises:

“Only take antibiotics when clinically necessary. Avoiding unnecessary antibiotics is the most effective way to protect the gut’s natural bacterial balance, because it is specifically the depletion of protective bacteria, and the bile acids and nutrients they help regulate, that creates the opening C. diff needs to establish an infection.

“Where antibiotics are unavoidable, choosing a narrower-spectrum option and the shortest effective course limits the amount of collateral damage done to the microbiome. If you develop diarrhoea while or after taking antibiotics, that is a reason to contact a GP rather than stopping the tablets on your own.”

Article ends – click to return to top or check out related resources below

Further reading and resources

Allergies, antibodies and antibiotics

Make sure you don’t miss out on news from Independent Living

return to top