What Pharmacists Can Do Better for Patients at Risk of C difficile Infection

Caitlin McClain, a Clostridioides difficile (C difficile) survivor, nurse, and board member and advocate for the Peggy Lillis Foundation, received fidaxomicin for roughly 10 to 11 months and credits her pharmacists with keeping her treatment on track. Because fidaxomicin is costly and not always in stock, discharges on a weekend could leave her scrambling, and she emphasized that even a 12- to 24-hour delay can be dangerous for patients. Her pharmacists called other locations, arranged couriers, dispensed a few tablets to bridge the gap, and confirmed that insurance authorizations were in place.

She described pharmacists as a key step in antibiotic stewardship after the ordering provider, stressing that antibiotics are lifesaving when used appropriately but are not benign. In her recovery, she relies on pharmacists to help her make safe medication choices, and a pharmacist recommended Saccharomyces boulardii (Florastor) to help rebuild her microbiome. She noted that although some antibiotics carry greater risk, any antibiotic—even a single dose—could trigger C difficile.

Despite these positive experiences, McClain said she has never been counseled by a pharmacist about C difficile specifically. Counseling has focused on diarrhea as a general adverse effect (AE) and on contacting the prescriber if dehydration occurs. Now, she discloses her history to every provider, and does the same for her children. She suggested that clearly explaining the difference between common antibiotic-related gastrointestinal AEs and C difficile infection could lead to earlier diagnosis and better prevention.