After completing a 5‑day course of metronidazole and cefuroxime for a Bartholin gland abscess, I now have nausea, abdominal pain, and three episodes of watery diarrhea—could this be an antibiotic side effect or a new condition such as Clostridioides difficile infection?

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Antibiotic-Associated Diarrhea vs. Clostridioides difficile Infection

Your symptoms are most likely antibiotic-associated diarrhea from the metronidazole and cefuroxime, but you need immediate stool testing for C. difficile toxin because watery diarrhea with abdominal pain after recent antibiotic use is a classic presentation of C. difficile infection (CDI), which can occur during treatment and up to 2 months after stopping antibiotics. 1, 2

Understanding Your Risk

Antibiotic Exposure Timeline

  • CDI can develop during antibiotic therapy and up to 2 months after cessation, with the highest risk occurring during treatment and in the first month following exposure (7-10 fold increased risk) 1, 2
  • You finished antibiotics only 1 day ago, placing you in the highest-risk window 1

Your Specific Antibiotics

Both medications you received carry significant CDI risk:

  • Cefuroxime (a second-generation cephalosporin): The CDC identifies cephalosporins as high-risk antibiotics for C. difficile infection 2
  • Metronidazole: While used to treat CDI, it can also contribute to antibiotic-associated diarrhea and disrupt normal gut flora 3, 4

Distinguishing Between Two Possibilities

Simple Antibiotic-Associated Diarrhea (Non-CDI)

  • Occurs in 5-25% of patients taking antibiotics 3
  • Usually mild, self-limited diarrhea 3
  • Typically resolves within days after stopping antibiotics 3

C. difficile Infection (More Serious)

Key warning signs you currently have:

  • Watery diarrhea (you've had 3 episodes) 1
  • Abdominal pain (you mentioned stomach pain after eating) 1
  • Nausea (present since yesterday) 1

Additional concerning features to monitor:

  • Fever >38.5°C 2
  • More than 3 unformed stools within 24 hours 1
  • Worsening abdominal cramping or distension 1

Immediate Action Required

Get Tested Now

Submit a stool sample for C. difficile testing immediately - the proper specimen is an unformed stool promptly submitted to the laboratory 1. Testing should include:

  • Enzyme immunoassays for C. difficile toxins A and B, OR
  • Real-time PCR for toxin B gene 1

Do not wait for multiple episodes - processing a single specimen at onset of symptoms is sufficient 1

Critical Pitfall to Avoid

Do not take anti-diarrheal medications (loperamide/Imodium) or opiates, as these can worsen CDI by preventing toxin elimination and potentially leading to toxic megacolon 1

Treatment Pathway Based on Test Results

If C. difficile Test is POSITIVE:

For non-severe CDI (which you likely have based on your description):

  • Oral vancomycin 125 mg four times daily for 10 days is now the preferred first-line treatment 1
  • Metronidazole 500 mg three times daily for 10 days is an acceptable alternative if vancomycin is not accessible due to cost 1, 2

Severity indicators that would require immediate medical attention:

  • Fever with temperature >38.5°C 2
  • White blood cell count >15,000 cells/μL 1
  • Severe abdominal pain with rebound tenderness 1
  • Rising creatinine (>50% above baseline) 1

If C. difficile Test is NEGATIVE:

Your symptoms are likely simple antibiotic-associated diarrhea:

  • Maintain adequate hydration (>1.5 L/day of fluids) 1
  • Reduce dietary fat and fiber temporarily 1
  • Consider probiotics (Saccharomyces boulardii or Lactobacillus species) to help restore gut flora 3
  • Symptoms should resolve within 3-5 days 3

When to Seek Emergency Care

Go to the emergency department immediately if you develop:

  • Fever >38.5°C 2
  • Severe abdominal pain or distension 1
  • Blood in stool 1
  • Signs of dehydration (dizziness, decreased urination, extreme thirst) 1
  • More than 6 watery stools in 24 hours 1
  • Inability to keep down fluids 1

Key Clinical Context

The fact that your Bartholin abscess has resolved (no pus, wound closed) is reassuring and suggests the antibiotics successfully treated the primary infection 5. However, this does not protect you from developing CDI as a secondary complication of antibiotic therapy 1, 2.

Bottom line: Contact your doctor today to arrange stool testing for C. difficile. Do not assume this will resolve on its own, as untreated CDI can progress to severe colitis. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

C. difficile Infection Risk with Antibiotic Use

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Treatment and prevention of antibiotic associated diarrhea.

International journal of antimicrobial agents, 2000

4
Research

Role of antibiotics for treatment of inflammatory bowel disease.

World journal of gastroenterology, 2016

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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