Which antibiotic is known for causing C. difficile infection as a side effect?

Clindamycin is well recognized for its association with Clostridioides difficile (C. difficile) infections. This antibiotic can disrupt the normal gut flora, allowing for an overgrowth of C. difficile bacteria, which can lead to antibiotic-associated diarrhea and more severe colitis. The mechanism behind this is the alteration of the intestinal microbiome due to the antibiotic's effect, which diminishes the diversity of bacteria in the gut, making it easier for opportunistic pathogens like C. difficile to thrive.

Other antibiotics listed may have a lesser association with C. difficile, but they are not as prominently linked. For example, while vancomycin is often used to treat C. difficile infections, it may also cause such infections when used inappropriately or in certain situations. Azithromycin and levofloxacin have different mechanisms of action and generally do not have the same level of association with C. difficile infections as clindamycin does. Therefore, the specific reputation of clindamycin for causing this complication highlights its potential risk when used, especially in patients who are elderly, have had prior antibiotic use, or have underlying health issues.