C. difficile in England is rising again, and it is now at a 13 year high
C. difficile is a bacterium that can infect the bowel. It was formerly called Clostridium difficile and was reclassified as Clostridioides difficile in 2016, which is why NHS material still carries both names. The current nomenclature record lists both as validly published.
The reason to read on is the trend. According to the UK Health Security Agency annual epidemiological commentary, England recorded 18,970 C. difficile cases in the 2024/25 financial year, a rate of 33.3 per 100,000 population. That is 12.7 percent more cases than 2023/24, when there were 16,838 cases at 29.4 per 100,000, and a 13.1 percent rise in rate.
Go back further and the picture is starker. The rate has risen 49.8 percent since 2020/21, when it stood at 22.2 per 100,000. C. difficile in England is now at its highest incidence since 2011/12.
None of this means the infection is back where it was. In 2007/08 England recorded 55,498 cases at 107.6 per 100,000, and by 2013/14 the rate had fallen to 24.7 per 100,000. What has changed is direction. A decline that ran for well over a decade stopped in 2021/22 and has been reversing since. UKHSA treated the increase as significant enough to open a formal investigation, published as a technical report on 1 May 2025.
What the risk looks like after 65
The national rate of 33.3 per 100,000 is an average across everyone in England, and it hides how unevenly C. difficile falls.
In 2024/25, people aged 85 and over had rates of 314.3 per 100,000 in males and 305.6 per 100,000 in females. That is roughly ten times the population rate.
Mortality tracks the same age gradient. Among males aged 85 and over there were 78.1 deaths per 100,000, with a case fatality rate of 24.9 percent. In the 75 to 84 age group there were 27.1 deaths per 100,000, with a case fatality rate of 18.0 percent.
Case fatality rate means deaths as a proportion of people who developed the infection, so it is not the chance of dying for someone who has never had C. difficile. It is the chance among people who have it. For an 85 year old man in England, that figure is about one in four.
Those are uncomfortable numbers to read. They are also why clinicians treat C. difficile in an older patient as a serious illness.
The symptoms, and the point at which to get help
NHS guidance lists the common symptoms of a C. difficile infection as diarrhoea, a high temperature, loss of appetite, feeling sick and a stomach ache.
Timing is the part that distinguishes it from an ordinary stomach upset. Symptoms usually begin during a course of antibiotics, or in the weeks after finishing one.
The NHS advises asking for an urgent GP appointment, or getting help from NHS 111, in three situations: diarrhoea while taking or having recently taken antibiotics, bloody diarrhoea or bleeding from the bottom, or diarrhoea lasting more than seven days.
One instruction is easy to get wrong. Do not take anti-diarrhoeal medicine such as loperamide, because it can stop the infection being cleared from the body.
Age is not the only thing that raises risk. The NHS also lists recent or current antibiotics, a long stay in hospital or a care home, a weakened immune system from a condition such as diabetes or kidney failure or from treatment such as chemotherapy, taking a proton pump inhibitor such as omeprazole or another medicine that reduces stomach acid, and having had C. difficile before.
Antibiotics are the main trigger, and refusing them is not the answer
Antibiotics disturb the normal bacteria in the bowel, which is what gives C. difficile its opportunity. The NICE evidence summary on broad-spectrum antibiotics found that the antibiotics most strongly associated with the infection were clindamycin, cephalosporins and quinolones. Co-amoxiclav and piperacillin-tazobactam are the antibiotics most frequently reported as being associated with C. difficile infections.
NICE advises prescribers to minimise:
- clindamycin
- second and third generation cephalosporins, with particular caution in older people
- quinolones
- carbapenems
- prolonged courses of aminopenicillins
Read that as guidance for prescribers, not as a list of drugs to argue about at the pharmacy counter. Untreated bacterial infection carries its own serious risks in older people, and a prescriber weighing an antibiotic has already balanced both. What the evidence supports is a conversation: is an antibiotic needed here, is this the narrowest one that will work, and how many days should the course run.
Hospital-onset cases have risen fastest
Hospital-onset cases, meaning those that begin during an inpatient stay, numbered 8,430 in 2024/25. That is 73.1 percent higher than in 2018/19, a much steeper climb than the overall rate.
Even so, hospital-onset cases were fewer than half of the 18,970 total. C. difficile is a community problem as well as a hospital one, and a course of antibiotics taken at home carries risk in the same way.
How C. difficile is treated
Treatment in England follows NICE guideline NG199, published on 23 July 2021.
- First episode: oral vancomycin 125 mg four times a day for 10 days.
- If vancomycin is not effective: fidaxomicin 200 mg twice a day for 10 days.
- A further episode within 12 weeks, classed as a relapse: fidaxomicin 200 mg twice a day for 10 days.
- A further episode more than 12 weeks later, classed as a recurrence: vancomycin or fidaxomicin.
- Life-threatening infection: higher-dose vancomycin with intravenous metronidazole, with specialist and surgical input.
- Bezlotoxumab: not recommended, on cost-effectiveness grounds.
NG199 also does not recommend prebiotics or probiotics for preventing C. difficile, which matters if you have been told a supplement will protect you.
Recurrence is the part people are not warned about
Finishing a course of treatment is often not the end of it. The UKHSA technical report states that recurrences of C. difficile infection are estimated to occur in up to 25 percent of treated patients, with 40 to 65 percent of patients experiencing multiple recurrences after a second or third episode respectively.
For adults who have had two or more previous episodes, NG199 says to consider a faecal microbiota transplant for a recurrent episode. NHS guidance says the same treatment may be offered if the infection comes back two or more times.
If you are caring for someone who has had C. difficile once, this is the fact worth holding on to. A second episode is not unusual, and there is a defined route for what happens after two.
What actually reduces the risk at home
The NHS page on C. difficile was last reviewed on 24 July 2025, and one instruction on it catches almost everybody out.
Do not use hand sanitiser. NHS guidance states plainly that hand sanitiser does not kill or remove C. difficile. Soap and water is what removes it from hands, and it needs doing regularly.
The other measures are short:
- Wash your hands regularly with soap and water.
- Clean the toilet and the area around it with disinfectant after each use.
- Ask, whenever an antibiotic is prescribed, whether it is needed and how long the course should be.
Those three do more than any supplement. If you are also reviewing other long-term health decisions in your sixties and seventies, our articles on what happens when statins are not enough and cutting down on alcohol cover the same ground of decisions taken with real numbers.
Clinical research into preventing C. difficile
Some studies in this area are investigating whether a vaccine might help prevent C. difficile infection in people at higher risk. Nothing about that is settled, and no study can promise a benefit to anyone taking part.
Panthera Biopartners is running a study investigating a potential vaccine in adults aged 65 and over at higher risk. Eligibility is set by the sponsor’s protocol, not by the clinic, and it is confirmed at a screening visit. Participation is voluntary and can be stopped at any time.
Studies of this kind typically define higher risk using recent healthcare contact. Examples of the criteria such a study might use, alongside being aged 65 or over, include a hospital stay of more than two nights in the past 12 months, two or more emergency department visits in the past 12 months, at least ten outpatient appointments in the past 12 months, oral or injectable antibiotics for more than 48 hours in the past 12 weeks, or a planned hospital admission of more than two nights. That is an illustration of the shape of the criteria, not a definitive list.
Frequently asked questions
How likely am I to get C. difficile if I am over 85?
In 2024/25 in England, the C. difficile rate in people aged 85 and over was 314.3 per 100,000 in males and 305.6 per 100,000 in females, about ten times the population average of 33.3 per 100,000. Age is the strongest signal in the surveillance data, and recent antibiotic use raises the risk further.
What are the symptoms of C. difficile?
The NHS lists diarrhoea, a high temperature, loss of appetite, feeling sick and a stomach ache. Symptoms usually start during a course of antibiotics or in the weeks afterwards. Ask for an urgent GP appointment or contact NHS 111 if you have diarrhoea while taking or having recently taken antibiotics, bloody diarrhoea, or diarrhoea lasting more than seven days.
Is C. difficile getting more common in the UK?
Yes. England recorded 18,970 C. difficile cases in 2024/25, up 12.7 percent on the previous year, and the rate has risen 49.8 percent since 2020/21. It is the highest incidence since 2011/12. UKHSA published a technical report on 1 May 2025 setting out its formal investigation into the increase.
Which antibiotics carry the highest C. difficile risk?
NICE found the antibiotics most strongly associated with C. difficile infection were clindamycin, cephalosporins and quinolones. Co-amoxiclav and piperacillin-tazobactam are the ones most frequently reported in association with cases. NICE advises minimising clindamycin, second and third generation cephalosporins in older people, quinolones, carbapenems and prolonged aminopenicillin courses.
Does hand sanitiser kill C. difficile?
No. NHS guidance states plainly that hand sanitiser does not kill or remove C. difficile, so it is the wrong product for this infection. Wash your hands regularly with soap and water instead, and clean the toilet and the area around it with disinfectant after each use. The NHS page was last reviewed on 24 July 2025.
What happens if C. difficile keeps coming back?
Recurrence occurs in up to 25 percent of treated patients, and 40 to 65 percent of those who have a second or third episode go on to have multiple recurrences. NICE guideline NG199 says to consider a faecal microbiota transplant for adults who have had two or more previous episodes.
Should I stop taking my antibiotics because of C. difficile?
No. Do not stop a prescribed antibiotic without speaking to the clinician who prescribed it, because untreated infection carries its own risks. The useful step is asking whether the antibiotic is needed, whether a narrower one would do, and how many days the course should run.
About Panthera
Panthera Biopartners is the UK’s largest Site Management Organisation for commercial clinical trials, with seven clinics in Glasgow, Enfield, Keele, Preston, Rochdale, Sheffield and York. Panthera does not conduct first-in-human studies. If you want to read what is involved, see the Clostridioides difficile clinical trials page, where a screening visit determines eligibility against the sponsor’s protocol and you have time to read a Participant Information Sheet and ask questions before consenting.
Disclaimer
Not medical advice. This article is general information about C. difficile and does not replace advice from your GP, pharmacist or hospital team. Do not change or stop any prescribed medicine on the basis of what you read here.
Conflicts and affiliations. Panthera Biopartners runs clinical trials, including studies relating to C. difficile. Whether any study is suitable for you is a decision to discuss with your own clinician and with the study team at a screening visit, and taking part is voluntary and can be stopped at any time.