Heightened Awareness, Effective Treatment Options Critical to C. difficile Management

When a patient enters a health care facility, whether it be for common disease management or emergency treatment, they expect to receive the best possible care for their condition and leave the facility healthier than when they entered. Oftentimes, patients who visit a health care center for treatment due to an infection receive antibiotics. Unfortunately, many who have recently taken a course of antibiotics or have stayed either at a hospital or nursing home are at elevated risk of acquiring Clostridioides difficile (C. diff), a bacterium that causes serious gastrointestinal complications.¹

C. difficile can cause diarrhea and colon inflammation, constituting a major public health threat. | Image Credit: © jumrass khlongkhaew - stock.adobe.com

Spread and Treatment of C. diff

Typically causing diarrhea or colitis, C. diff is responsible for almost half a million US infections yearly. Anyone can contract C. diff, but the use of antibiotics upsets the balance between helpful and unhelpful bacteria in the gut microbiome, allowing normally controlled levels of C. diff to grow uncontrollably. When a person is infected, C. diff bacteria release spores, which can spread to others through skin and other surfaces. This is partly why C. diff spreads so easily in health care facilities, locations that contain many potentially at-risk individuals living close together.^2,3

Options for treatment are limited. If the C. diff infection is related to an antibiotic, the first course of action will likely be ceasing use of the specific medicine. Historically, the treatment of mild-to-moderate infection consisted of metronidazole (Flagyl; Pfizer), but response rates have waned as more resistant strains of C. diff have emerged. Current standard options include glycopeptides such as vancomycin (Firvanq; Azurity Pharmaceuticals) or fidaxomicin (Dificid; Merck & Co.), which can be used as main treatments for C. diff-associated diarrhea and inflammation.^3,4

For serious C. diff infections, metronidazole can be used as an intravenous formulation or in combination with vancomycin. Research indicates that patients with serious disease who are unresponsive to metronidazole experience significantly improved response rates with vancomycin, supporting its role as an effective C. diff treatment management. Despite the positive responses that many with C. diff have to these treatments, about 25% of patients who are treated for C. diff experience a repeat infection.^3,4

Risk of Recurrence and Pharmacists’ Role

Repeat infections can occur if the first C. diff infection never went away or the bacteria caused an entirely new infection. Patients older than 65 years who are taking antibiotics for another condition while on antibiotics targeting C. diff or who have a severe medical condition are at higher risk of repeat infection. Antibiotic therapy can be used once again—often a different one from the one used at first—though it should be noted that antibiotic therapy works less with each recurrence of C. diff. Given the risk of recurrence, ease of spread, and changes in composition of the bacteria, C. diff remains a major public health threat, especially in vulnerable populations such as older adults and children.⁴

Pharmacists play an essential role in patient monitoring and advocacy when treating C. diff. Along with individual efforts, organizations such as the Peggy Lillis Foundation are critical in providing a support system for patients and caregivers. In an interview following a presentation at the Peggy Lillis Foundation’s 2025 C. diff Summit, Stacy A. Khan, MD, attending physician at Boston Children’s Hospital in Massachusetts, emphasized the importance of pharmacists staying up to date on available C. diff literature while collaborating within their multidisciplinary teams to improve treatment outcomes for infected patients.^5,6

“What you learned when you were getting your master’s degree in pharmacy or your bachelor's may not hold true anymore,” Khan explained. “Certainly, when I did training, metronidazole was the first-line treatment for C. difficile. We now know that, in most cases, there are other treatments that are much more effective and have a higher chance of achieving a cure and don't have the same kind of effects that are so unpleasant.”⁵

Education of Patients, Providers is Paramount

As they did when the COVID-19 pandemic emergency required unprecedented cooperation and imperative efforts on the part of pharmacists, these same efforts can be interpreted within the context of preventing C. diff infections. Antimicrobial stewardship programs help patients optimize their use of antibiotics and can lead to a substantial reduction in C. diff infections. Educating patients on optimal lifestyle changes to prevent C. diff and strategies to reduce symptoms over the course of their infection are key roles of pharmacists as well.^6,7

Pharmacists are also able to recommend novel approaches, such as fecal microbiota transplant, which involves the transfer of healthy donor stool to an affected patient and can help prevent recurrent C. diff infections. Organizations, including the Peggy Lillis Foundation, continue to advocate for funding and research into this novel approach and others that have the potential to transform C. diff treatment.^6,7

“Patient education and support really make a difference,” Bruce E. Hirsch, MD, infectious disease physician at Northwell Health, said in an interview. “When your patient understands what he or she is going through, it is empowering the patient, and I do think that patient knowledge is such an important part of adherence and understanding how to take medications appropriately.”⁷

REFERENCES

1. CDC. C. diff—About C. diff. Last Updated December 18, 2024. Accessed June 16, 2025. https://www.cdc.gov/c-diff/about/index.html#cdc_disease_basics_symptoms-symptoms

2. Cleveland Clinic. C. diff (Clostridioides difficile infection). Last Reviewed November 19, 2024. Accessed June 16, 2025. https://my.clevelandclinic.org/health/diseases/15548-c-diff-infection

3. Mayo Clinic Staff. C. difficile infection. Mayo Clinic. Last Updated September 1, 2023. Accessed June 16, 2025. https://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/drc-20351697

4. Shen EP, Surawicz CM. Current treatment options for severe Clostridium difficile—associated disease. Gastroenterol Hepatol (NY). 2008;4(2):134-139. PMID: 21904490; PMCID: PMC3088840. https://pmc.ncbi.nlm.nih.gov/articles/PMC3088840/

5. Khan SA, Hippensteele A. The pediatric C. difficile surge and what pharmacists can do. Pharmacy Times. Published April 22, 2025. Accessed June 16, 2025. https://www.pharmacytimes.com/view/the-pediatric-c-difficile-surge-and-what-pharmacists-can-do

6. Hirsch BE, Hippensteele A. The power of knowledge: Patient education is a tool in preventing C. difficile recurrence. Pharmacy Times. Published April 22, 2025. Accessed June 16, 2025. https://www.pharmacytimes.com/view/the-power-of-knowledge-patient-education-is-a-tool-in-preventing-c-difficile-recurrence

7. Spigelmyer A. Pharmacists are key players in C difficile infection prevention. Pharmacy Times. Published March 25, 2025. Accessed June 16, 2025. https://www.pharmacytimes.com/view/pharmacists-are-key-players-in-c-difficile-infection-prevention