Use of broad?spectrum antibiotics is associated with an increased incidence of Clostridium difficile infection. This briefing reviews the evidence assessing the risk of C. difficile infection associated with individual broad?spectrum antibiotics based on the highest quality published evidence.

Antibiotic guidelines steadily adopted that evidence and prescribing of cephalosporins and quinolones decreased over the decade to 2013/14 in primary and secondary care in England.
However, over the same period, the prescribing of combination penicillins increased: co?amoxiclav prescribing increased in primary and secondary care and piperacillin?tazobactam prescribing increased in secondary care.

With further clarification of the epidemiology following the establishment of the C. difficile ribotyping network service, these combination penicillins have become the antibiotics most frequently reported as being associated with C. difficile infections.
These data should be interpreted with caution and should not be considered to indicate conclusively which antibiotics have the highest risks of C. difficile infection.

Three meta?analyses in people with hospital?associated and community?associated C. difficile infection confirmed that the antibiotics most strongly associated with the infection were clindamycin, cephalosporins and quinolones.

However, the interpretation of data on the risk of C. difficile with different antibiotics is extremely difficult. Such data should be interpreted with caution and should not be considered to definitively show which antibiotics or subgroups of antibiotic classes carry higher risks of C. difficile infection.

Although the data have limitations that prevent firm conclusions, the evidence shows the importance of following antibiotic guidelines that recommend that all broad?spectrum antibiotics are prescribed appropriately and with careful stewardship.

G Mohan.