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Clinical Case Challenges: Treatment of C. difficile Infection

This educational activity is sponsored by the Academy for Continued Healthcare Learning (ACHL) and supported by educational grants from Ferring Pharmaceuticals Inc., and Merck & Company.


Sahil Khanna, MBBS, MS
Associate Professor of Medicine
Gastroenterology and Hepatology
Mayo Clinic
Rochester, MN

Kevin W. Garey, PharmD, MS
Professor and Chair
University of Houston College of Pharmacy
Houston, TX


The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in a CME/CE/CPE activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been resolved prior to this CME/CE/CPE activity.

The following financial relationships have been provided:

Sahil Khanna, MBBS, MS
Sources of Funding for Research: Ferring Pharmaceuticals, Inc., Rebiotix, Inc
Consulting Agreements: Facile Therapeutics, Inc., Premier Inc., Probiotech LLC, Shire PLC

Kevin W. Garey, PharmD, MS
Sources of Funding for Research: Merck and Company, Paratek Pharmaceuticals, Inc., Summit Pharmaceuticals International, Tetraphase Pharmaceuticals, Inc. 
Consulting Agreements: Merck and Company, Summit Pharmaceuticals International

Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Investigational approaches to treating C. difficile infection and reducing recurrent episodes.


acpeThe Academy for Continued Healthcare Learning is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This activity has been approved for 0.75 contact hours.

UAN: 0396-0000-20-019-H01-P

Type of Activity: Knowledge 
Media: Internet

Fee Information: There is no fee for this educational activity.
Estimated time to complete activity: 45 minutes


August 31, 2020


August 31, 2021


This activity is intended for gastroenterologists, primary care physicians, pharmacists and other clinicians who care for patients at risk of C. difficile infection.


This activity will take approximately 45 minutes to complete. To receive credit, participants are required to view the online activity, and complete the posttest and evaluation. To receive credit, 80% must be achieved on the posttest. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.

For questions, contact Karen Catino at kcatino@achlcme.org.


Dr. Sahil Khanna and Dr. Kevin Garey use a case-based approach to walk participants through the selection of therapy for two patients with C. difficile infection.  Discussion topics include risk factors, triaging severity of infection, and guideline-recommended therapies.  Clinical decision points throughout the activity allow learners to test their skills in managing patients with C. difficile, identify risk factors, and treat with available antimicrobial therapies.


Recurrent episodes of C. difficile continue to pose a significant burden on patients, clinicians, and the healthcare system. The management of recurrent and refractory C. difficile is complex and challenging. This activity will review the role of the gut microbiome in C. difficile infection, discuss evidence-based guidelines for treatment and prevention of recurrent infection, and describe emerging restoration approaches that reduce complications and improve clinical outcomes.


Upon completion of this activity, participants will be able to:

  • Discuss the selection of antimicrobials considerate of their impact on gut microbiota and the role of antitoxins in the treatment and prevention of recurrent CDI
  • Assess available and updated clinical guidelines to ensure evidence-based therapeutic selection for treatment and prevention of recurrent CDI
  • Explain the role of the gut microbiome in relationship to C. difficile infection and approaches to restoration for prevention of recurrent infection
  • Describe clinical risk factors that increase a patient’s risk for recurrent and multiply recurrent C. difficile infection
  • Describe available and emerging approaches for patients with recurrent C. difficile who have failed appropriate antibiotic therapy


Case 1: The Assessment and Treatment of Initial and Recurrent CDI – Kevin W. Garey, PharmD, MS
Case 2: Treatment of Recurrent C. difficile: Current and Future Directions – Sahil Khanna, MBBS, MS


Please ensure the computer system you plan to use meets the following minimum requirements:

  • Operating System: Windows 98 or higher & Macintosh 2.2 or higher
  • Internet Browser (Mac &/Windows): Internet Explorer 6.0 or higher, Google Chrome, Safari 5.0.6 or higher, Firefox 3.0.3 or higher & Opera 5 or higher
  • Broadband Internet connection: Cable, High-speed DSL & any other medium that is internet accessible
  • Monitor Screen Resolution: 320 x 480 or higher
  • Media Viewing Requirements: Adobe Reader, Microsoft PowerPoint, Flash Player & HTML5

Disclosure of Unlabeled Use and Disclaimer

The content for this activity was developed independently of the commercial supporters. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

This educational activity was planned and produced in accordance with the ACCME Accreditation Criteria, Policies, and Standards for Commercial Support, as well as the ACPE Accreditation Standards for Continuing Pharmacy Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers’ prescribing information for these products. ACHL requires its speakers to disclose that a product is not labeled for the use under discussion.