Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Diarrhoea - antibiotic associated - Management
How should I manage antibiotic-associated diarrhoea once results of C. difficile toxin test are known?

If the Clostridium difficile toxin test result is negative:

  • Continue management as outlined in C. difficile not suspected or awaiting result.
  • Consider re-testing for C. difficile toxin (24 hours after testing the first sample) only if there is strong clinical suspicion of C. difficile infection (see Testing). Consider seeking specialist advice if in doubt.

If the C. difficile toxin test result is positive:

  • Reassess the person's clinical condition.
    • For information on assessing severity of C. difficile infection, see Additional information in the section on Assessment.
    • If they have features of severe or life-threatening C. difficile infection, or their condition is rapidly deteriorating, admit to hospital.
    • If the person's condition has improved considerably or has resolved without treatment, consider the possibility of a false-positive test result.
  • If hospital admission is not required:
    • Consult local policy or seek specialist advice on further management (including antibiotic treatment — see Additional information).
    • Assess whether there is a risk of a C. difficile outbreak — for example, among other elderly residents in a care or nursing home.
    • Stop any antibiotics not being used for treating C. difficile infection, if this is appropriate. Seek specialist advice if this is not possible and the diarrhoea is severe.
    • Manage fluid loss and symptoms as for acute gastroenteritis (for further information, see the CKS topic on Gastroenteritis).
    • Avoid the use of antimotility drugs (such as loperamide) to treat diarrhoeal symptoms. If possible, avoid other drugs with anti-peristaltic effects (such as opioids).
    • Do not recommend the use of probiotics for the treatment and prevention of C. difficile infection.
    • Give advice on hygiene measures to minimize the spread of C. difficile (see the section on Preventing spread of infection in the CKS topic on Gastroenteritis).
    • Review the person daily and monitor for signs of increasing severity of disease, as they may deteriorate very rapidly.
    • Advise people that:
      • The diarrhoea should resolve in 1–2 weeks.
      • They remain infectious while they are still ill and have symptoms.
      • They should not return to work or school until they have been free from diarrhoea for 48 hours.

© NHS Institute for Innovation and Improvement