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Clostridioides difficile in the community

Checked: 23-10-2022 by 3 Vicky Ryan Next Review: 23-10-2023


When to suspect C. difficile infection

If any of the following are present:

  • Diarrhoea is not clinical attributable to any other cause (eg laxatives).
  • Currently prescribed or recent course of antimicrobials.
  • Is or has been a hospital inpatient or resident in an institution.


If C. difficile infection is suspected then request a stool sample for routine culture as well as C difficile toxin testing (ICE request)

Please note toxin can remain positive for weeks/months. If repeat testing is required within 28 days this should be discussed with a Microbiologist.

Please note C difficile toxin testing is not undertaken in those aged 2 and under.


Please see the full BNSSG Treatment of C diff guidelines on the page below:

5. Infections Guidelines (Remedy BNSSG ICB)


If recurrence/relapse is suspected please discuss cases with Microbiology. Please review C diffogenic medications such as antimicrobials, laxatives or PPIs.

Prevention of C Diff

GPs should carefully consider the use of antibiotics, particularly those antibiotics that are more likely to be associated with C. difficile

1 Recommendations | Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use | Guidance | NICE

When prescribing antimicrobials, prescribers should follow local guidelines on:

  • prescribing the shortest effective course

  • the most appropriate dose

  • route of administration.

 Please see BNSSG Primary Care Antimicrobial Guidelines on use of antibiotics

Patient information

Please see the attached BNSSG patient information leaflet Clostridioides difficile - Symptoms and treatment

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.