The clostridium difficile (C. difficile) bacterium is one of the most common causes of infection of the large bowel (colon) in the United States, affecting millions of patients yearly. Patients taking antibiotics are at risk of becoming infected with C. difficile. Antibiotics disrupt the normal bacteria of the bowel, allowing C. difficile bacteria to become established in the colon. Many persons infected with C. difficile bacteria have no symptoms. These people become carriers of the bacteria and can infect others. In other people, a toxin produced by C. difficile causes diarrhea , abdominal pain, severe inflammation of the colon (colitis), fever , an elevated white blood count, vomiting and dehydration . In severely affected patients, the inner lining of the colon becomes severely inflamed (a condition called pseudomembranous colitis). Rarely, the walls of the colon wear away and holes develop (colon perforation), which can lead to a life-threatening infection of the abdomen.

Although the antibiotic clindamycin (Cleocin) has been widely recognized as causing C. difficile colitis, many commonly prescribed antibiotics have been implicated. Typically, diarrhea and abdominal pain occur during or shortly after antibiotic treatment. Sometimes, symptoms of colitis may not appear for weeks following antibiotics.

C. difficile is extremely common in the environment. It can be found on bedpans, furniture, toilet seats, and the floors of hospitals, nursing homes, and extended care facilities. It appears to only cause disease, however, when patients are treated with antibiotics. Several outbreaks have been reported in nursing homes. C. difficile has also become a significant infection in the general population.

In patients suspected of having C. difficile infection, stool samples can be collected to detect the bacteria and/or its toxins. Using a viewing tube inserted into the colon through the anus (flexible sigmoidoscopy examination), the doctor can detect the damage to the inner colon lining caused by the C. difficile toxin.

Treatment of C. difficile colitis involves correction of dehydration, discontinuing the antibiotics, and substituting antibiotics specifically active against C. difficile bacteria. Antibiotics which are effective for C. difficile include metronidazole (Flagyl), and vancomycin (Vancocin). In most patients, appropriate treatment leads to improvement in 2-3 days and complete resolution in 10 days. Approximately 20% of patients so cured can experience a relapse of C. difficile infection with recurrent symptoms. Some patients can experience more than one relapse. Active research is ongoing to find better treatment for patients with relapses.

Antibiotics are extremely important medications to help fight infections. C. difficile colitis should not deter from the appropriate use of antibiotics. However, since many antibiotics can cause C. difficile infection, all antibiotics should be used prudently. Self administration, or using antibiotics without accurate diagnosis or proper indications should be discouraged.

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