Facing a C. difficile infection or recurrence
Are you wondering if you have a C. diff infection or have been diagnosed with one? Or have your C. diff symptoms come back? Making sense of it all can be a challenge. C. diff can be an all-consuming and complex experience. We’re here to help. This is where you’ll learn about C. diff symptoms, treatment options, and everything in between. Get the knowledge you need to face C. diff.
C. diff: The inside story
Let’s start with the basics. Gain a better understanding of C. diff and what to expect during this illness. What you learn may
help when making health-related choices with your doctor.
What is a C. difficile infection?
C. diff is short for the name of the germ that causes the infection: Clostridioides difficile
(say it like klos-TRID-e-OY-dees dif-uh-SEEL)—also known as C. diff.
C. diff can affect anyone. The risk of getting it is higher for people who1:
- Are taking, or have recently taken, antibiotics
- Have spent some time in a hospital or in a long-term care facility
(a nursing home, for example)
- Have a weakened immune system
- Are 65 years of age or older
When C. diff germs take hold and multiply in the gut (intestines), they can wreak havoc.
The most common symptoms—watery diarrhea, nausea, stomach pain or
cramps—can last for days. If not treated right away, C. diff can lead to serious
medical problems for the person who has it. A severe C. diff infection can even be fatal.1,2
Many people may not realize that getting a relapse of the infection is highly possible—anywhere between 2 and 8 weeks
after the first infection. This is called recurrent C. diff.3-6
C. diff is very contagious and can become a serious health threat to others in the home and the community.1,7,8
Understanding C. diff infection
The American Gastroenterological Association (AGA) helps explain C. diff.
Know the symptoms
C. diff infection can take people by surprise. They may think “It’s just a stomach bug!” or some other familiar
digestive problem. It’s important to recognize the symptoms and know when to go to the doctor for help.
- Watery diarrhea 3 or more times a day for more than 1 day
- Mild abdominal cramping and tenderness
Moderate to severe infection1,8
- Watery diarrhea, as often as 10 to 15 times a day
- Abdominal cramping and pain, which may be severe
- Rapid heart rate
- Increased white blood cell count
- Kidney failure
- Blood or pus in the stool
How can you get C. diff?
C. diff is very contagious and it’s important to be aware of ways it can spread1,8:
Someone who has C. diff can
spread the germs to people
Someone who may be caring
for a person with C. diff may pick
up the germs and pass them on.
If a person with C. diff does not wash
their hands after using the bathroom,
the germs can spread to others who
touch the things they touched.
Did you know? You can have C. diff germs in your body but not get sick. You can still be
a “carrier” and spread the germs to others who may develop a serious infection.
When to see a doctor8
Don’t be afraid to seek medical help if your symptoms last for more than 2 days. Let your doctor know if you have:
- 3 or more watery stools a day
- A new fever
- Severe abdominal pain or cramping
- Blood in your stool
Tests to confirm a C. diff infection
Most often, the doctor will ask for a sample of your stool (poop). Different lab tests may be done to check the sample for
C. diff bacteria.8
For severe C. diff cases, the doctor may also ask for other tests to check the inside of the colon (large intestine). Imaging tests are sometimes done to help reveal other possible problems related to C. diff. For example, to check for any damage to the lining of your colon, special x-ray equipment is used. An x-ray of the abdomen or a computerized tomography (CT) scan are examples of imaging tests the doctor may order.9
How to keep C. diff from spreading
In hospitals and other healthcare facilities—and in patients’ homes—strict
routines for cleanliness need to be in place9,10:
- Hand hygiene. Wash hands with soap and warm water before and after using the bathroom,
and before and after eating
- Control contact. People with C. diff need to be isolated in a private room, with a bathroom only
they will use
- Use protective gear. Disposable gloves or gowns may be required when near visitors in the hospital
- Disinfect and clean thoroughly. Use products that contain chlorine bleach to kill bacteria. Ordinary alcohol-based cleaners or sanitizers do not kill C. diff.
Understanding current C. diff treatment options
To understand how to get C. diff under control, let’s take a look at where it can first take hold: deep inside the gut
(intestines). Explore the amazing gut microbiome and the role it plays in overall health. Let’s learn about C. diff treatment
options your doctor may recommend.
C. diff and the microbiome connection
There is an amazing hidden world inside our bodies called the gut microbiome.
Think of it as our own collection of microscopic life forms—microbes that play
a role in how our bodies work. The gut microbiome (in the stomach and intestines)
is home to trillions of microbes, both good and bad, that can affect our health.11-13
Health in the balance
A balanced microbiome helps your body in many ways.12-14
- It aids with the way the body breaks down and absorbs nutrients from food
- It works with the immune system to protect you from infection
- New research also links the microbiome to blood sugar control, brain function, heart health, and overall gut health
Did you know? An imbalance in the microbiome may give harmful bacteria like C. diff the chance to take hold and grow in
the gut. This can lead to a C. diff infection. Microbiome imbalance also plays a role in medical problems such as irritable
bowel syndrome (IBS) or inflammatory bowel disease (IBD).2,14
A healthy microbiome with diverse bacteria.
A gut microbiome that has been taken over by C. diff.
Antibiotics and C. diff
Antibiotics are the go-to treatment for a C. diff infection
and can be effective.10,15
- For a first-time infection, doctors prescribe 10-day
treatment with an antibiotic to treat C. diff 10,15
- For a recurrent C. diff infection, antibiotic treatment may
last for several weeks. The doctor also may slowly
decrease or pulse how often the dose is given10,15
A concerning reality
Antibiotics are given to help wipe out disease-causing
bacteria. However, they can take down some of the good
microbes, too. This disrupts the delicate balance of the
microbiome—making it possible for C. diff to take hold.10,15,16
A frustrating cycle
Using antibiotics for extended periods of time, or using
more than one antibiotic for treating an illness, can also
raise the risk of C. diff. This may also lead to a cycle of
recurring C. diff infections.3,4,17-19
Fecal Microbiota Transplantation (FMT)
FMT is a treatment that helps add back good microbes
and organisms into the gut and helps rebalance the
microbiome. FMT may be a good option to consider for
people who have had C. diff multiple times, after
- With FMT, first a healthy donor provides stool, which is
used to make a solution to be used in the treatment
- This solution may be placed into the colon of the
person with C. diff during a colonoscopy or upper
endoscopy, or with a simple enema (through the
rectum) done by the doctor
- FMT may also be available in pill form21
- FMT has been shown to have an overall cure rate as
high as 95% for C. diff
Talk to your doctor about the C. diff treatment option that may be right for you.
Not again?! C. diff can come back
Just when it seems C. diff is done and gone, it comes roaring back. Even after treatment, some people experience repeat
infections—this is called recurrent C. diff. The symptoms go away, but then return within 2 to 8 weeks.1,3
C. diff by the numbers
caused by C. diff
who get a C. diff infection
are likely to get it again21
After the first
recurrence, up to
6 IN 10
are likely to get
another C. diff
8 IN 10
with recurrent C. diff
were hospitalized in
12 months, and at
least 3 separate
Recurrent C. diff can turn life upside down
The effects of recurrent C. diff sometimes go beyond physical pain. It can trigger depression and other mental health
concerns, too. People have described how C. diff has taken a toll on their lives24:
- Many people struggle with other physical effects of C. diff—loss of energy, appetite, or sleep
- A C. diff infection, with the constant diarrhea and other symptoms, may strain a person’s relationships with family,
friends, or significant others
- C. diff has forced people to limit or give up travel, outdoor activities or events, and even enjoying different types of food
If you are feeling this way, talk with your doctor or a mental health professional for guidance and support.
We’re here for you
Learn about staying healthy during and after C. diff. See stories of strength from patients. Understand the role of food and
nutrition in recovery. Find information you can trust, and tools you can use to move in a positive direction.
Stories of strength
With almost half a million cases of C. diff infections every year, why don’t we hear more about it? See hopeful stories of
people who have struggled with and overcome C. diff.
Join our patient and caregiver community
Be part of our Community Panel
Your experience matters. Share your story
and help and inspire others facing C. diff.
Get C. diff news, information, tips,
and more—just for you.
Food: friend or foe?
People experiencing C. diff lose their appetite, or fear that food will trigger diarrhea. However, good nutrition is vital to
recovery. The body needs to regain strength and rebuild gut health. Make sure to ask your doctor about what you can
eat during and after C. diff.
According to the Mayo Clinic, a supportive diet may include25:
- Plenty of fluids to prevent dehydration—choose drinks that contain water, salt, and sugar. For example, watered-down
juices, soft drinks, or broths
- Starchy foods, such as potatoes, noodles, rice, wheat, or oatmeal
- Simple foods, such as saltine crackers, bananas, soup, and boiled vegetables
Talk with your doctor or a nutritionist to guide C. diff-friendly food choices.
Fact or fiction? C. diff and food
Experts continue to study how nutrition—and boosting the microbiome—can help with recovery after C. diff. There is so
much to learn. Do you know which of these is fact or fiction?
Milk and milk products are helpful after a C. diff infection
- FICTION: After a C. diff infection, some people may have symptoms of irritable bowel syndrome (IBS). As a result, they can become lactose intolerant—unable to take in milk and other dairy foods. Nutrition experts advise avoiding these foods for at least 2 to 4 weeks.26
Certain diets may help improve or decrease the chances of getting a C. diff infection
- FACT: Several studies have shown that a Western diet (high protein, high fat, low fiber) or a gluten-free diet may reduce the variety of microbes in the microbiome, while a vegan, or plant-based, diet may build diversity in the microbiome, which may help protect against C. diff infection.26
Fiber-rich foods (beans, grains, fruits, and vegetables) or supplements can help with recovery after C. diff
- FACT: Fiber-rich foods have been shown to help with some medical conditions like IBS, constipation, and with some symptoms that come after a C. diff infection. For example, supplements with a plant-based fiber called psyllium help absorb liquid and bulk up the stool for C. diff patients.26
Coffee or other drinks with caffeine are okay to take while recovering from C. diff
- FICTION: Avoid coffee and other caffeinated drinks, at least for a short time, after a C. diff infection because they may cause digestive problems.26
Stay away from greasy foods or spicy foods while recovering from C. diff
- FACT: Avoid greasy or spicy foods while recovering from C. diff as they may also cause digestive problems.26
Talk with your doctor or a nutritionist to guide C. diff-friendly food choices.
What about probiotics and prebiotics?
Probiotics are live microbes that may provide health benefits and may help improve or restore microbial balance within the gut. Probiotics are not drugs or medicine and are not regulated by the FDA.15,17,29
Prebiotics are a type of fiber found in food that may help increase the amount of beneficial bacteria in the gut.
Medical experts are still studying the many types of probiotics and prebiotics to learn if they provide a medical benefit for treating a C. diff infection. Before taking prebiotic or probiotic supplements, it is important to ask your doctor if they can help your condition, which ones to take, and how much.
C. diff Info Center
is the leading patient and healthcare global organization for educating and advocating for C. difficile. It is composed of 100% volunteer professionals. Together, they are dedicated to supporting public health through education and advocating for C. difficile infection prevention, treatments, clinical trials, and environmental safety worldwide.
is building a nationwide C. diff awareness movement by educating the public, empowering advocates, and shaping policy. The Foundation website is a resource for information and to get involved with helping raise awareness about C. diff infections.
More information sources
From the (CDC):
“The Progression of a C. diff
Infection gives” you quick facts
on what to expect with a C. diff
(AGA): “Navigating Your C. diff
Diagnosis” is helpful reading for
patients and caregivers.
1. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015;372(16):1539-1548. 2. Bien J, Palagani V, Bozko P. The intestinal microbiota dysbiosis and Clostridium difficile infection: is there a relationship with inflammatory bowel disease? Therap Adv Gastroenterol. 2013;6(1):53-68. 3. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-834. 4. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55(suppl 2):s154-s161. 5. Smits WK, Lyras D, Lacy DB, Wilcox MH, Kuijper EJ. Clostridium difficile infection. Nat Rev Dis Primers. 2016;2(16020):1-47. 6. Kelly CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect. 2012;18(suppl 6):21-27. 7. Guh AY, Mu Y, Winston LG, et al, for the Emerging Infections Program Clostridioides difficile Infection Working Group. Trends in U.S. burden of Clostridioides difficile infection and outcomes. N Engl J Med. 2020;382(14):1320-1330. 8. Fernandez-Garcia L, Blasco L, Lopez M, Tomas M. Clostridium difficle infection: pathogenesis, diagnosis and treatment, Clostridium difficile – A Comprehensive Overview, Shymaa Enany, Intech Open, DOI: 10.5772/67754. Available from: 9. Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment , and prevention of Clostridium difficile infection. Am J Gastroenterol. 2013;108(4):478-498. 10. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. 11. Gilbert JA, Blaser MJ, Caporaso JG, Jansson JK, Lynch SV, Knight R. Current understanding of the human microbiome. Nat Med. 2018;24(4):392-400. 12. Antharam VC, Li EC, Ishmael A, et al. Intestinal dysbiosis and depletion of butyrogenic bacteria in Clostridium difficile infection and nosocomial diarrhea. J Clin Microbiol. 2013;51(9):2884-2892. 13. Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-1836. 14. Marchesi JR, Adams DH, Fava F, et al. The gut microbiota and host health: a new clinical frontier. Gut. 2016;65(2):330-339. 15. Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. 2021;73(5):e1029-e1044. 16. Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 2016;8(1):39. 17. Riddle DJ, Dubberke ER. Clostridium difficile infection in the intensive care unit. Infect Dis Clin North Am. 2009;23(3):727-743. 18. Leong C, Zelenitsky S. Treatment strategies for recurrent Clostridium difficile infection. Can J Hosp Pharm. 2013;66(6):361-368. 19. Nelson WW, Scott TA, Boules M, et al. Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis. J Manag Care Spec Pharm. 2021;27(7):828-838. 20. Staley C, Khoruts A, Sadowsky MJ. Contemporary applications of fecal microbiota transplantation to treat intestinal diseases in humans. Arch Med Res. 2017;48(8):766-773. 21. Kao D, Roach B, Silva M, et al. Effect of oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial. JAMA. 2017;318(20):1985-1993. 22. Rodrigues R, Barber GE, Ananthakrishnan AN. A comprehensive study of costs associated with recurrent Clostridioides difficile infection. Infect Control Hosp Epidemiol. 2017;38(2):196-202. 23. Unni S, Scott T, Boules M, Teigland, C, Parente A, Nelson W. Healthcare burden and costs of recurrent Clostridioides difficile infection in the Medicare population. Presented at: AMCP 2020; April 21-24, 2020; Houston, Tx. 24. Lurienne L, Bandinelli P, Galvain T, Coursel CA, Oneto C, Feuerstadt P. Perception of quality of life in people experiencing or having experienced a Clostridioides difficile infection: a US population survey. J Patient Rep Outcomes. 2020;4(1):14. 25. Mayo Clinic website. 2021 C. difficile – Diagnosis and treatment. Accessed September 25, 2021. 26. Ward C, Kelly CR. Clostridioides difficile infection: Is there a role for diet and probiotics? Pract Gastroenterol. 2020; 44(9): 26-34. 27. Centers for Disease Control and Prevention website. 2021 Regulatory Oversight and Safety of Probiotic Use. Accessed September 25, 2021.