What is my risk level of having Clostridioides difficile (C. diff) infection given my recent Augmentin (amoxicillin-clavulanate) use and long-term Proton Pump Inhibitor (PPI) usage with Omeprazole?

Your Risk of C. difficile Infection is Low but Present

Given your recent 10-day course of Augmentin combined with long-term PPI use, you have an elevated risk of C. difficile infection compared to someone without these exposures, but your absolute risk remains relatively low—particularly since you are one month post-antibiotic completion and in an outpatient setting.

Understanding Your Risk Factors

Recent Antibiotic Exposure

• Augmentin (amoxicillin-clavulanate) is a moderate-risk antibiotic for C. difficile infection, though it carries lower risk than fluoroquinolones, clindamycin, or third-generation cephalosporins 1, 2
• Your risk was highest during the 10-day treatment course and in the first month afterward (which you are currently completing), with risk elevated up to 6-fold during this period 1, 3
• The risk remains somewhat elevated for up to 3 months after antibiotic cessation, though it progressively decreases 3
• Even a 10-day course increases risk, as duration >10 days has been specifically associated with CDI 1

Long-term PPI (Omeprazole) Use

• Your chronic PPI use independently increases your C. difficile risk with an odds ratio of approximately 1.74 for incident CDI 1
• The combination of antibiotics plus PPI creates synergistic risk (OR 1.96), meaning the two exposures together increase risk more than either alone 1
• However, the absolute risk remains modest: in the general population on PPIs, the number needed to harm ranges from 899-3,925 patients 1
• For hospitalized patients on both antibiotics and PPIs, the number needed to harm drops to 28-50, but you are not currently hospitalized 1

Protective Factors in Your Case

• You are in an outpatient/community setting, which carries substantially lower baseline CDI risk than hospitalized patients 1, 3
• You are pregnant (not elderly), and advanced age is one of the most important risk factors for CDI—you lack this major risk factor 2, 3
• You received only one antibiotic (not multiple concurrent antibiotics), which significantly reduces risk compared to patients receiving 2+ antibiotics (HR 2.5 for 2 antibiotics, HR 9.6 for ≥5 antibiotics) 1, 4
• You completed your antibiotic course one month ago, placing you past the highest-risk window 1, 3

Probiotics and Your Risk

The probiotics you took do not provide proven protection against C. difficile infection 1

• The IDSA/SHEA guidelines state there are insufficient data to recommend probiotics for primary prevention of CDI outside clinical trials 1
• While some meta-analyses suggest potential benefit, the studies with the strongest effects had baseline CDI rates 7-20 times higher than expected, potentially biasing results 1
• Your probiotic use was reasonable but should not be considered protective in risk assessment 1

What to Watch For

You should monitor for symptoms of C. difficile infection, which include 3:

• Diarrhea: ≥3 unformed stools within 24 hours
• Abdominal pain, cramping, or distension
• Fever >38.5°C (101.3°F)
• In severe cases: bloody diarrhea, severe abdominal pain, or signs of systemic illness

If you develop new-onset diarrhea, seek medical evaluation promptly 3

• Any unexplained diarrhea during or after antibiotic therapy warrants stool testing for C. difficile toxins 3
• Early recognition is critical, as delayed diagnosis can lead to progression to severe or fulminant colitis with significantly increased morbidity and mortality 3

Risk Mitigation Going Forward

Consider discussing PPI necessity with your obstetrician 1:

• Given that PPIs are often overprescribed and you have completed antibiotics, evaluate whether continued omeprazole is medically necessary during pregnancy 1
• If PPI therapy is essential for your condition, continue it—but if it's being used for mild symptoms that could be managed otherwise, discontinuation would reduce your CDI risk 1
• Switching to an H2-receptor antagonist (like ranitidine or famotidine) carries lower CDI risk than PPIs if acid suppression is still needed 1

Avoid unnecessary antibiotics in the future 1:

• Minimize antibiotic exposure whenever clinically appropriate
• If antibiotics are needed, shorter durations and avoidance of high-risk classes (fluoroquinolones, clindamycin, third/fourth-generation cephalosporins) reduce CDI risk 1, 2

Bottom Line

Your absolute risk of developing C. difficile infection is low but measurably elevated compared to baseline. The combination of recent Augmentin use and chronic PPI therapy creates additive risk, but you lack several major risk factors (hospitalization, advanced age, multiple antibiotics, ongoing antibiotic exposure). Most importantly, you are now one month past antibiotic completion, moving beyond the highest-risk period. Remain vigilant for symptoms, but do not be overly concerned—the vast majority of patients with your exposure profile do not develop CDI.