Prevent the Downward Spiral: Restoring the Gut Microbiota to Reduce Recurrent C. difficile Infection

Released On
December 8, 2020

Expires On
December 8, 2021

Media Type

Completion Time
75 minutes

Gastroenterology, Hospitalist, Infectious Disease, Pharmacy

Clostridium difficile

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Supported by an educational grant from Ferring Pharmaceuticals, Inc.

Credit Available

  • Physicians — maximum of 1.25 AMA PRA Category 1 Credit(s)
  • Pharmacists — 1.25 contact hours.

All other health care professionals completing this course will be issued a statement of participation.

Target Audience

This activity is intended for ID specialists, hospitalists, internists, physicians, pharmacists and other clinicians who care for patients at risk of serious Clostridioides difficile infection.

Statement of Need/Program Overview

C. difficile recurrence continues to pose a significant burden on patients, clinicians, and the healthcare system. Clinicians require up-to-date knowledge of guideline recommended antimicrobial therapies and emerging therapies for patients who fail antibiotic therapy. In this activity, Teena Chopra, MD, Paul Feuerstadt, MD, and Kevin Garey, PharmD, will discuss the role of the gut microbiota, management of C. difficile infection in special populations, the safety and efficacy of fecal microbiota transplantation, and emerging microbiota restoration therapies.

Learning Objectives

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

  • Evaluate the role of the gut microbiome in relationship to C. difficile infection and approaches to restoration for prevention of recurrent infection
  • Discuss clinical risk factors that increase a patient’s risk for recurrent and multiply recurrent C. difficile infection
  • Review guideline recommendations for the management of first and subsequent recurrences of C. difficile infection
  • Describe available and emerging approaches for patients with recurrent C. difficile who have failed appropriate antibiotic therapy


Paul Feuerstadt, MD, FACG, AGAF (Chair)

Gastroenterology Center of Connecticut
Assistant Clinical Professor of Medicine
Yale University School of Medicine
Hamden, CT

Teena Chopra, MD, MPH

Professor of Medicine, Division of Infectious Diseases
Corporate Medical Director, Infection Prevention, Epidemiology and Antibiotic Stewardship
Detroit Medical Center
Wayne State University
Director, Infection Prevention, Epidemiology and Antibiotic Stewardship
Vibra Hospital
Detroit, MI

Kevin W. Garey, PharmD, MS, FASHP

Professor and Chair
Department of Pharmacy Practice and Translational Research
University of Houston College of Pharmacy
Houston, TX

Physician Continuing Medical Education

Accreditation Statement

The Academy for Continued Healthcare Learning is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

The Academy for Continued Healthcare Learning designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Continuing Education

Accreditation Statement

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

Credit Designation

This activity has been approved for 1.25 contact hours.

ACPE Universal Activity Number 0396-0000-20-048-H01-P

Type of Activity


Disclosures of Conflicts of Interest

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:

Paul Feuerstadt, MD, FACG, AGAF

  • Advisory Board: Ferring Pharmaceuticals, Inc., Rebiotix Inc.
  • Consulting Agreements: Merck and Company, Ferring Pharmaceuticals, Inc., Rebiotix Inc., Roche Diagnostics, Seres Therapeutics
  • Speakers' Bureau: Merck and Company

Teena Chopra, MD, MPH

  • Speakers Bureau: Allergan, Cepheid, Melinta Therapeutics, Inc., Merck & Company, Pfizer
  • Consulting Agreements: Cepheid, Shionogi, Inc.
  • Data and Safety Monitoring Board Chair (DSMB): Ferring Pharmaceuticals, Inc.

Kevin W. Garey, PharmD, MS

  • Sources of Funding for Research: : Paratek Pharmaceuticals, Inc., Summit Pharmaceuticals International, Tetraphase Pharmaceuticals, Inc.
  • Consulting Agreements: Summit Pharmaceuticals International

Disclosure of Unlabeled Use

Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Therapies under investigation for C. difficile


Section 1: Introduction to C. difficile Infection – Teena Chopra MD, MPH

  • Epidemiology
  • Risk factors
  • Pathogenesis
  • Diagnosis
  • Treatment

Section 2: Special Populations with C. difficile Infection: Getting off the CDI Recurrence Escalator – Kevin W. Garey, PharmD, MS

  • Stem cell transplant
  • Inflammatory bowel disease
  • Chronic kidney disease

Section 3: FMT for the Treatment of CDI – Paul Feuerstadt, MD, FACG, AGAF

  • Microbiome
  • Shifts in the microbiome seen with CDI
  • Foundational studies in CDI
  • Safety of FMT
  • Pharmaceutically produced therapies

Instructions for Participation and Credit

This activity will take approximately 75 minutes to complete. To receive credit, participants are required to complete the pretest, 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.

CPE credit will be submitted to CPE Monitor on the first day of each month.

Course Viewing Requirements

  1. Active Internet connection (DSL or Cable). Dial-up connection will have constant buffering problem.
  2. Compatible with Windows PC and MAC (256 MB of RAM or higher)
  3. Activity is best viewed on Internet Explorer 9.0 or higher, Safari 5.0 or higher and Firefox 29.0 or higher
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  5. Adobe Reader to print certificate. Click here to download Adobe Reader for free.
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The content for this activity was developed independently of the commercial supporter. 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 grantor.

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 the speaker to disclose that a product is not labeled for the use under discussion.

Contact Information:

For questions, contact Melissa Stradal at