C. diff Treatment: What to Know

Clostridium difficile infection, often called C. diff, is a bacterial infection in the gut.

C. diff is a type of bacteria that can commonly transmit the infection to individuals in health care settings, such as hospitals, rehab facilities, and skilled nursing facilities. Most C. diff infections are associated with recently taking antibiotics for an infection or other issues.

C. diff can cause various symptoms, most commonly diarrhea, abdominal cramping, indigestion, stomach upset, and bloating.

If a C. diff infection progresses and becomes more complicated, it can develop into colitis, a generalized inflammation of the gut. Colitis is a more severe form of C. diff infection and requires intensive therapy and often a hospital stay. Another more severe form of C. diff colitis is a disorder known as toxic megacolon, a condition associated with severe systemic illness and toxicity.

This article discusses the causes, symptoms, diagnosis, and treatment for C. diff.

A person with C. diff lying in a hospital bed.

Morsa Images / Getty Images

What Causes It?

C. diff infection is caused by a bacteria known as clostridium difficile (C. difficile). It is a bacteria that lives in the human gut. People can transmit C. diff through contact with another person who has C. diff or by touching an environmental surface, like a handrail or a toilet seat, contaminated with C. diff. Note that hand sanitizer does not kill C. diff; you must wash your hands with soap and water.

C. diff is easily transmitted, particularly in health care environments like:

  • Hospitals
  • Nursing facilities
  • Rehab facilities

How Does C. diff Spread?

C. diff is a very infectious bacteria known to spread quite easily. In health care settings, where C. diff is often acquired, the spread is controlled by taking precautions such as wearing gloves, gowns, and facial shields in combination with thorough hand washing.

C. diff is known to cause outbreaks and can rapidly spread amongst people in the hospital or other health care settings.

For this reason, people with C. diff are often restricted to specific rooms in a hospital or health care setting during an active infection. In addition, family members and healthcare workers who come into contact with a person with C. diff need to take extra precautions to limit the spread, including washing hands frequently and donning contact isolation safety gear. 

Risk Factors for C. diff Infection

The biggest risk factor for C. diff infection is recent antibiotic usage.

Since antibiotics target bacteria in the body, they can disrupt the natural microbiome of the gut. This can lead to the development of C. diff infection. In addition, prior infection with C. diff can also increase the likelihood of developing a future infection.   

Risk factors include:

  • Antibiotic use (Clindamycin, cephalosporins, fluoroquinolones) 
  • Chemotherapy agents (5FU, lenalidomide, doxorubicin)  
  • Recent surgery (gastric sleeves, gastric bypass, colon surgery) 
  • Enteral nutrition (tube feeding) 
  • Prior C. diff infection 

C. diff Symptoms

A C. diff infection can be very uncomfortable. Most people will report ongoing diarrhea and discomfort in the belly. The most common symptoms are:

  • Diarrhea
  • Bloating
  • Flatulence
  • Nausea
  • Vomiting
  • Fever

As C. diff infection becomes more severe, the nature and intensity of these symptoms can also increase. This is considered the development of a more complicated form of C. diff known as colitis.

With colitis, the intestines become inflamed and irritated. If the symptoms progress, a medical emergency known as toxic megacolon, where the entire intestinal tract is disrupted, can develop.

Toxic megacolon is a medical emergency and requires urgent treatment. 

C. diff Diagnosis

There are several ways to diagnose a C. diff infection using diagnostic tests of the blood and stool.

Some diagnostic tests attempt to look at the specific levels of C. diff in the stool. This is known as a nucleic amplification test. Other diagnostic tests rely on the detection of a toxin that is produced by C. diff bacteria. 

Other blood tests that evaluate the levels of white blood cells in the body can be used to help identify a C. diff infection.

Additionally, imaging tests to examine the intestines, such as CT scans and X-rays, may also be used to aid in the diagnosis of C. diff and the complications of C. diff, such as colitis.

Finally, direct inspection of the colon using a camera during a colonoscopy procedure can also identify a C. diff infection, though this is usually only used in severe cases. 

C. diff Treatments

There are many treatment options available for C. diff infection. Selecting the best treatment is based on evaluating the severity of infection and number of C. diff prior infections. 

Oral Antibiotics

The treatment of C. diff infection is aimed primarily at eliminating the C. diff bacteria with antibiotics. Specifically, the oral antibiotic vancomycin is the most commonly used treatment for C. diff infection.

Alternatively, treatment with the antibiotics metronidazole and fidaxomicin are also commonly used for infection with C. diff. All of these antibiotics are given orally, via pills that you can swallow, so the medication can pass through the digestive system and reach the colon. Since C. diff bacteria reside in the colon, this is the area where the antibiotic most needs to work. 

Intravenous (IV) Antibiotics

Intravenous antibiotics are administered through an IV directly into the bloodstream. These antibiotics do not pass through the digestive system and the colon, so they are not frequently used to treat C. diff infection. If the C. diff  infection is severe, IV metronidazole may be used for treatment.

Fecal Microbiota Transplant

Repeated infections with C. diff may result in the development of antibiotic resistance. Resistance means the C. diff bacteria can no longer be treated effectively with antibiotics such as vancomycin and fidaxomicin.

In cases of ongoing and repeated infections with C. diff, your healthcare team may recommend a new procedure known as a fecal microbiota transplant when your bacterial microbiome is replaced with other bacteria from a donor. The procedure involves a colonoscopy where a healthcare provider visualizes the colon with a small camera and then transfers bacteria from another person into your colon.

Fecal microbiota transplants are a relatively new procedure, but they have shown efficacy in treating frequent C. diff infections as well as severe C. diff infections that are not responding to antibiotics.  

Surgery

In severe cases, surgery for C. diff may be necessary, though it is reserved for cases of severe infection. The surgery involves removing the infected parts of the bowel. By removing the infection, the surgery can significantly improve symptoms but carries risks and often requires the surgeon to make an alternative opening in the body for waste removal called a stoma.

Natural Remedies for C. diff

Since antibiotics can potentially disrupt the microbial population in the body, alternative treatments for C. diff infection have been explored.

The most extensively studied alternative treatments are probiotics, which help to increase the diversity and population of microbes in the gut. Importantly, none of these natural remedies have been shown to be as effective as antibiotics at treating C. diff. 

C. diff Diet

Some people with C. diff have reported improvements in their symptoms when they modify their diet to include foods rich in bacteria, like fermented vegetables and foods, as well as soft and easy-to-digest foods.

While medical research has not yet identified the best diet for C. diff, there are many diets that do help with digestive issues. Some diets, such as the low-FODMAP diet, help with diarrhea and irritable bowel syndrome (IBS). 

Probiotics

Since antibiotics eliminate and disrupt the bacteria that naturally live in the gut, probiotics have been used to help replace the lost bacteria.

Different studies have evaluated the benefits of probiotics among those with C. diff infection and show mixed effects. Some evidence suggests probiotics may help, especially when administered alongside antibiotics to treat C. diff while other studies show no significant benefit from probiotics.

Currently, probiotic treatments are not medically recommended by the American Gastroenterological Association or Infectious Disease Society of America based on their lack of evidence; however, there are ongoing studies in this area. 

Black Seed Oil

In experiments, black seed oil, and a particular component called thymoquinone, have been shown to limit the growth of C. diff bacteria in laboratory cultures.

The experiments showed that thymoquinone may have an impact on C. diff bacteria and limit their ability to grow. However, no studies have evaluated the usage of black seed oil in people or people with C. diff, so its safety and potential effects remain unknown. At this time, black seed oil is not a medically recommended treatment for C. diff infection.

Myrrh Water Extract

In experiments, myrrh water extract was shown to limit the growth of C. diff bacteria in laboratory studies. The experiments found that myrrh water extract may have an impact on C. diff bacteria and limit their ability to grow. However, no studies have evaluated the usage of myrrh water extract in people, or people with C. diff, so its effects remain unknown. At this time, myrrh water extract is not a medically approved treatment for C. diff infection. 

Complications of C. diff

The most serious complications of C. diff infection are colitis and toxic megacolon. Colitis is a general inflammation of the intestines and is a sign of severe infection. Toxic megacolon is a medical emergency that occurs when the intestines become obstructed. Toxic megacolon is a serious and potentially fatal condition that requires prompt treatment. 

Can You Prevent C. diff?

The best way to prevent C. diff is properly washing your hands and practicing good hygiene, especially before eating. Since C. diff infection can be transferred from person to person, it is best to always sanitize your hands properly after meeting someone, after shaking hands, or after coming into contact with a surface.  

In addition, work with your healthcare provider to make sure you are not taking any unnecessary medications.

Signs That C. diff Is Coming Back

You may notice C. diff infection has come back if you notice increased watery or runny bowel movements, abdominal cramping, or indigestion. Other symptoms of C. diff, such as vomiting, nausea, or fever, may be signs of a recurrence of C. diff infection. 

How to Prevent C. diff From Recurring

C. diff recurrence is difficult to predict or anticipate. You can ensure the best chance of preventing recurrence by completing a full course of antibiotics for treatment. Some diets may also help prevent symptoms from recurring. 

Outlook With C. diff

C. diff is a bacterial infection that can cause severe diarrhea and cramping. It is treatable with antibiotics and rest. If you have a C. diff infection, it may take several days or even weeks to feel normal. 

Summary

Clostridium difficile, or C. diff, is a bacterial infection that can cause diarrhea and upset stomach. The best treatment for C. diff is antibiotics that you can get from your healthcare provider. You should seek medical care if you develop severe symptoms from C. diff, including fever or low blood pressure. Natural remedies, including probiotics, have been explored as an additional treatment for C. diff, but they are not a replacement for antibiotics. 

A Word From Verywell

A C. diff infection can be uncomfortable and frankly distressing. Know that there are treatments available for C. diff infection and that, in time, this will pass. If you have had a C. diff infection in the past, there are treatment options to help reduce your risk of a recurrence. Consult with your healthcare provider about the best options available to you. 

Frequently Asked Questions

  • Can C. diff go away on its own?

    C. diff infection is the result of an invasive bacteria and often requires treatment with a specific antibiotic you can get from a healthcare provider. C. diff can sometimes progress in severity and become a medical emergency that requires prompt treatment and evaluation. If you suspect you have C. diff, then seek medical care. 

  • Once you have C. diff do you always have it?

    Once you have C. diff, you will always have some level of bacteria that lives within the gut, so it may never go away. This is called “colonization” which describes that C. diff is now a part of the normal microbial population in your gut. However, this does not mean that you will have symptoms all the time. Adequate treatment can resolve the illness associated with a C. diff infection and some people may never experience symptoms again.  

 

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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