Clostridioides difficile (C. diff) is a spore-forming bacterium that can cause a range of illness from mild diarrhea to life-threatening colitis. Risk increases after antibiotic exposure, which can disrupt the normal gut microbiome and allow C. diff to proliferate. For a comprehensive overview, see the full [C. diff guide](https://www.innerbuddies.com/blogs/gut-health/clostridioides-difficile-c-diff-guide). What to recognize: common symptoms include watery diarrhea (three or more loose stools per day), abdominal cramping, fever, nausea, and dehydration. Severe cases may progress to toxic megacolon, sepsis, or bowel perforation. Older adults, hospitalized patients, recent antibiotic users, and individuals with weakened immune systems or inflammatory bowel disease are at higher risk. Transmission and prevention: C. diff spreads via the fecal–oral route. Spores are environmentally hardy and can persist on surfaces for months. Prevention relies on hand hygiene (soap and water is preferable to alcohol hand rubs for spore removal), appropriate disinfection with EPA-approved sporicidal agents in healthcare settings, and judicious antibiotic prescribing to limit unnecessary disruption of the gut microbiome. Diagnosis and clinical approach: Diagnosis typically uses stool assays that detect C. diff toxins or toxigenic genes (PCR). In complicated or severe presentations, endoscopy or abdominal imaging may be necessary to assess for complications. Treatment is evidence-based: first-line oral vancomycin or fidaxomicin for initial episodes, with higher-intensity regimens for severe disease. Metronidazole is now less commonly used as first-line therapy. Recurrent disease occurs in roughly 20–30% of patients after initial treatment and may require strategies such as targeted antibiotics, monoclonal antibodies against toxin B, or fecal microbiota transplantation (FMT) under clinical supervision. Role of the gut microbiome: A diverse, balanced microbiome helps resist colonization by pathogens including C. diff. Antibiotics, chemotherapy, and other factors that reduce microbial diversity increase vulnerability. Restoring microbial balance — through controlled clinical interventions, appropriate diet, and supportive therapies — is a key component of reducing recurrence risk. Practical steps to reduce risk: - Avoid unnecessary antibiotics and discuss alternatives with your clinician when appropriate. - Maintain rigorous hand-washing, especially after restroom use and before food handling. - Ensure high-touch surfaces in communal and clinical settings are cleaned with sporicidal agents. - Support gut health with a fiber-rich diet that encourages microbial diversity; discuss any probiotic use with a healthcare provider, as evidence for benefit is context-specific. Further technical reading on microbiome testing and consumer versus healthcare perspectives is available at Gut microbiome testing: why different for consumers and healthcare professionals, and on microbiome relevance for athletic performance at Gut microbiome & endurance sports. An example product reference (informational placeholder) is microbiome test information. When to seek care: contact a healthcare professional for persistent diarrhea after antibiotics, signs of severe illness (high fever, bloody stools, severe abdominal pain), or symptoms suggesting dehydration. Management decisions should be individualized and based on clinical severity, diagnostic testing, and current guidelines.