Primary Care in Rochester and Kasson

What you need to know about Clostridium difficile infection

12/21/2020 by Denise Dupras, M.D., Ph.D.


Clostridium difficile (C. diff.) is an infection that most commonly presents as diarrhea. It is typically a complication of antibiotic therapy. It is becoming more common and can cause a life-threatening illness. And increasingly it does not always follow antibiotic therapy. 

While C. diff. typically starts five to 10 days after antibiotic therapy, it can occur as soon as one day after therapy. Also, it can begin months after a course of antibiotic therapy. 

Mild illness related to C. diff. is usually associated with three or more watery stools and crampy abdominal pain that lasts for two or more days. More severe illness related to C. diff. can result in more than 10 stools per day, severe pain, and symptoms consistent with dehydration that require hospitalization. 

The intestines contain up to 2,000 kinds of normal bacteria, many of which keep you healthy. Taking an antibiotic to treat infection can destroy some of the normal helpful bacteria. This can create an imbalance in your intestines where the overgrowth of C. diff. can create diarrhea. This is one reason your health care provider may discourage the use of an antibiotic without a proven bacterial cause of infection. 

Mayo Clinic lists these antibiotics as being most-strongly associated with the development of C. diff.:

  • Fluroquinolones
  • Cephalosporins
  • Penicillins
  • Clindamycin

Other medications, like omeprazole and pantoprazole (which are types of proton pump inhibitors), have been associated with the development of C. diff. 

Bottom line: 

  • Don't take antibiotics if you don't need them. 
  • If you take antibiotics and develop diarrhea, which means more than three stools within 24 hours, contact your primary care provider. 

Denise Dupras, M.D., Ph.D., is a general internist in the Division of Community Internal Medicine. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.