Should I get checked for C. Difficile if I have a stomachache, cramps and hard stools after an antibiotics course?

Thank you for your question.

Diarrhoea is a relatively common side effect experienced during or after completing a course of antibiotics. This may also be associated with belly discomfort and bloating, but is usually self-limiting, short-lived and not associated with fever.

Clostridium difficile or C. Diff infection has a spectrum of manifestations ranging from asymptomatic carriage to severe or fulminant disease. Common presenting symptoms are watery diarrhoea, bloody diarrhoea, fever with abnormal laboratory parameters such as elevated white cell count. Severe disease may present with severe abdominal pain, dehydration, lactic acidosis and hypotension (low blood pressure), and may lead to bowel perforation. Risk factors for C. Diff infection include (1) Antibiotics such as clindamycin, fluoroquinolones, cephalosporins and penicillin, (2) recent hospitalization, (3) age >65, (4) use of proton pump inhibitors.

I echo my colleague’s opinion that conditions such as irritable bowel syndrome are more common causes of abdominal cramps and altered bowel habits. However, if (1) your symptoms persist, (2) there are other symptoms such as unintentional weight loss, poor appetite, bloody stools, (3) you have any of the risk factors for C. Diff infection listed above, or (4) you have a family history of gastrointestinal conditions (eg colon cancer, inflammatory bowel disease), I would strongly recommend that you seek a formal consultation with a specialist for a detailed review.

Based on your story alone, it's very unlikely that you have C. Diff, nor do you need to worry about getting tested for it, especially because (I presume) that you are fairly young.

C. Diff causes really smelly diarrhoea, and usually happens in the hospitalised elderly after a prolonged cause of strong antibiotics.

If I were in your shoes, I wouldn’t worry at all about getting tested for C. Diff.

However if the cramps and hard stools continue bothering you, do see your GP who can perform a proper examination, and prescribe some symptomatic oral medication. He can also help to rule out other causes for your diarrhoea, especially if they are of a recurrent nature eg. Irritable bowel syndrome, inflammatory bowel disease and coeliac disease.

Cheers

Stomachache, cramps and hard stools seem to suggest an issue of constipation more than C. Difficile infection. Try increasing your water and fibre intake as well as exercise more, these simple measures may help.

C. Difficile infection, although related to prior use of antibiotics, mostly presents with fever or diarrhoea. Effective treatment includes stopping unnecessary antibiotics and adequate hydration. Such simple measures may be good enough for recovery. Presence of any trace of C. Difficile in stools needs no additional treatment once a person recovers from his or her symptoms.

As such, testing for C. Difficile may be more an academic exercise unless there is an indication for more aggressive treatment from persistent or worsening symptoms.

Dr Quan