C.difficile (C.diff) - Treating Clostridium difficile infection

You will only need treatment for a Clostridium difficile infection if you have symptoms.

No treatment is needed if the bacteria are living harmlessly in your digestive system.

Mild infection

If you have mild symptoms of a C. difficile infection, it is best to stop taking the antibiotics that may have caused the infection, if possible. This will allow the natural mixture of bacteria to regrow in your gut.

In many cases where the symptoms are mild, stopping the antibiotics is often enough to ease the symptoms and clear the infection.

Moderate to severe infection

If you have symptoms that are more troublesome, such as severe diarrhoea or colitis (swelling and irritation of the bowel), you may need to take an antibiotic that can kill C. difficile bacteria.

The first treatment will usually be metronidazole, but vancomycin or fidaxomicin may be used as an alternative in severe cases. This should ease the symptoms within two to three days, though it can take around 7 to 10 days to make a complete recovery.

Possible side effects of these antibiotics are stomach ache, feeling sick and being sick.

Treating relapses

In around one in four cases, the symptoms of C. difficile infection return, usually within a week of completing treatment. This is known as a relapse.

The recommended treatment option for a first relapse is usually to repeat the original course of treatment.

If you experience a second relapse, a 14-day course of vancomycin may be recommended, or an additional antibiotic such as fidaxomicin or rifaximin.

If you then go on to experience further relapses, you may be referred to a specialist in the treatment of persistent C. difficile infections.

There are a number of treatment options available:

• a longer course of vancomycin – the dose is gradually reduced over several weeks
• repeat courses of antibiotics such as fidaxomicin  
• faecal transplantation
• immunoglobulins – these contain concentrated antibodies that are prepared from blood donations

Faecal transplantation

Another newer treatment option for recurring C. difficile infections is faecal transplantation. This involves a sample of faeces being taken from a healthy donor and placed into the colon of someone with a C. difficile infection using a catheter. Alternatively, it may be placed using a thin tube through the nose into the small bowel below the stomach.

The donated sample restores the normal balance of bacteria inside your digestive system with that from the healthy donor.

While this may sound unpleasant, the treatment does have very good results, with a success rate of more than 90%, and is probably the best treatment currently available. However, access to this type of treatment may be limited.