Clostridium difficile associated diarrhoea: diagnosis and treatment

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

John Starr, consultant physician (js011q1400@blueyonder.co.uk)

University of Edinburgh

While John Starr was working as a senior registrar at the Hammersmith Hospital in London, an upsurge in episodes of Clostridium difficile associated diarrhoea seemed to be associated with increasing use of third generation cephalosporins. This article seeks to clarify some of the diagnostic problems and help with appropriate treatment of this condition.

Introduction

Clostridium difficile associated diarrhoea is a serious condition with a mortality of up to 25% in frail elderly people.1 It affects older, frailer, hospitalised patients and also younger patients who are immunosuppressed.

Cross infection by C difficile is common in neonatal units, but neonates do not seem to develop C difficile associated diarrhoea.

The diagnosis of C difficile associated diarrhoea depends on:

Presence of diarrhoea, defined as an increase in stool liquidity usually accompanied by an increased frequency of bowel motions. A formal cut-off is the passing of more than 300 ml of liquid stool in 24 hours
Detection of toxins produced by C difficile in the stools.

The patient may also experience abdominal pain and have systemic features of malaise, fever, dehydration, and delirium. A pseudomembranous colitis is present in severe cases. In this state there is sloughing of the colonic epithelium, which is severely inflamed due to the cytotoxic action of C difficile.

C difficile associated diarrhoea is classically associated with clindamycin, but it may occur after exposure to a wide range of antibiotics.

Symptoms usually start during antibiotic treatment or shortly afterwards. Symptoms can be delayed by a few weeks, so it is worth asking patients whether they are currently taking, or have recently taken, antibiotics.

How does it happen?

C difficile is spread by the faecal-oral route, albeit indirectly through spores left on surfaces. C difficile is an anaerobic, Gram positive, spore forming bacterium that is the major identifiable cause of antibiotic associated diarrhoea.