Walk into any clinic with a mild fever or sore throat, and chances are you’ll leave with a prescription for antibiotics. For decades, these drugs have been our miracle cure, transforming once-lethal infections into manageable conditions and saving millions of lives. Their use is so common that even those outside the medical field are familiar with the term. What many don’t realise, however, is that antibiotics come with hidden consequences. One of the most alarming is the rise of Clostridioides difficile (C difficile), a bacterium that flourishes when antibiotics disrupt the body’s natural defences.
Our intestines house trillions of ‘good’ bacteria — the gut microbiome — which aid digestion, produce vital nutrients, support immunity, and protect us from harmful invaders. “Broad-spectrum antibiotics, however, can wipe out both harmful and protective bacteria, disturbing this delicate balance. When protective gut flora are destroyed, an ecological vacuum is created where C difficile can multiply unchecked,” explains Dr Ajesh Raj Saksena, senior consultant surgical oncologist at Apollo Hospitals.
Not all antibiotics pose the same risk, but some are especially notorious — fluoroquinolones, clindamycin, broad-spectrum cephalosporins, and piperacillin–tazobactam among them. Once C difficile takes hold, consequences can range from persistent watery diarrhea and severe abdominal pain to life-threatening complications such as toxic megacolon, septic shock, or even death. Far from being rare, this threat is growing, as shown by a large study from Sheba Medical Centre in Israel, recently published in JAMA Network Open.
According to Dr Ajesh, the study tracked more than 33,000 hospital admissions over six years. Patients who were C difficile–negative upon admission but received broad-spectrum antibiotics nearly doubled their risk of developing hospital-onset infections, with piperacillin–tazobactam carrying the highest hazard ratio. Prolonged or repeated antibiotic courses worsened the danger. Another group — ‘silent carriers’ — entered hospitals already harbouring the bacterium without symptoms. These patients were 27 times more likely to develop infections compared to noncarriers. In fact, infections developed in 4.1% of carriers versus just 0.1% of noncarriers, underscoring how dramatically risk differs between groups.
Dr Pavan Kumar Reddy N, medical director and head of critical care medicine at Arete Hospitals, Gachibowli, simplifies the study, saying, “When patients are admitted, a rectal swab test can identify silent carriers. These patients don’t have diarrhea but still carry the bacteria, which puts them at much higher risk. Antibiotics worsen the situation, but the bacteria itself is dangerous enough.” He stresses that hospitals must monitor such patients closely, test promptly if diarrhea develops, and enforce strict hygiene measures like extra cleaning and thorough handwashing.
The burden of C difficile is not equally distributed. Elderly patients with weakened immunity, those with multiple health conditions requiring frequent hospitalisations, individuals on proton pump inhibitors, and those with a history of prior infections are particularly vulnerable. Silent carriers, though outwardly healthy, live with an invisible burden that can become dangerous during hospital stays. Adding to the challenge is the bacterium’s ability to produce spores — resilient structures that survive for months on hospital surfaces, resist standard disinfectants, and spread through contaminated equipment or the unwashed hands of healthcare staff. “Alcohol-based sanitisers, widely used in hospitals, do not kill spores; only thorough handwashing with soap and water is effective. In crowded wards or where hygiene lapses, these spores become hidden time bombs,” warns Dr Ajesh.
The lessons from the Israeli study and doctors’ insights point toward urgent changes in hospital practice. Antibiotics should be prescribed only when absolutely necessary, with a preference for narrow-spectrum drugs and shorter treatment durations. Screening patients on admission, especially those recently hospitalised or transferred from long-term care, could help identify carriers early. Infection control must go beyond routine cleaning to include soap-and-water handwashing, contact precautions like gloves and gowns, and surface cleaning with agents that kill spores. For carriers, future strategies may involve probiotics, microbiome-restoring therapies, or novel drugs like monoclonal antibodies.
Yet the responsibility doesn’t lie with hospitals alone. Patients and their families can play a decisive role. Asking doctors whether antibiotics are truly needed, understanding the risks of repeated courses, and insisting on strict hygiene during hospital stays are small but powerful steps towards prevention.