Antibiotic exposure leads to overgrowth of Clostridium difficile (C. diff) in the bowel which leads to increased toxin production and causes mucosal damage, inflammation and necrosis.
Profuse watery or mucoid diarrhea +/- bloody, tenesmus, fever, abdominal cramps, tenderness, usually within 1 week of antibiotic therapy.
Signs of perforation, peritonitis, sepsis and shock or toxic megacolon.
FBC - Increased WBC
LFT – decreased albumin
EUC/CMP – electrolyte disturbance and renal dysfunction
Stool cultures - unformed stool only
AXR – thumbprinting, toxic megacolon
CT abdo- diffuse thickening colon wall
Markers of severity
50% increase in baseline Creatinine
Resuscitation with IV fluids +/- inotropes
Correct electrolyte disturbances
Early surgical referral – may require colectomy
Stop offending drugs
Mild-moderate: oral metronidazole 400mg (10mg/kg) 8 hourly for 10 days (can be given IV)
Severe: oral vancomycin 125mg (3mg/kg) 6 hourly for 10 days (IV not effective)
Disposition will depend on the patient co-morbidities and severity of diarrhoea and infection
Hand hygeine (i.e. washing with soap and water) is very important as it kills the spores.
Further References and Resources
Trubiano, J. A. et al. (2016) 'Australasian Society for Infectious Diseases guidelines for the diagnosis and treatment of Clostridium difficile infection', Journal of Internal Medicine, vol. 46, no. 4, pp. 479-493.
eTG - Clostridium Difficile