2 Indications and current treatments
2.1 Clostridium difficile is a bacterium that lives harmlessly in the gut of approximately 5% of healthy people. The use of broad-spectrum antibiotics and immunosuppressive agents can alter the balance of bacterial species in the gut, resulting in an overgrowth of C. difficile. Symptoms of mild C. difficile infections include purulent watery diarrhoea, abdominal cramps, nausea and dehydration. In more severe cases the infection can cause bloody diarrhoea and fever. In a few people C. difficile infection can lead to pseudomembranous colitis, sepsis, toxic megacolon, colonic rupture, and death. The risk of death increases in patients with multiple comorbidities.
2.2 First-line treatment involves rehydration and antibiotic therapy. Clinical responses are generally favourable but some people have recurrent or refractory C. difficile infections. For these people, further courses of antibiotics are used. An example of management algorithms can be found in Public Health England's Updated guidance on the management and treatment of Clostridium difficile infection (June 2013).