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Best Practice in First-Line Management of Clostridioides difficile: Practical Patient Cases and Expert Perspectives

  • Authors: Mark H. Wilcox, MD 
  • CME Released: 11/23/2022
  • Valid for credit through: 11/23/2023, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US gastroenterologists, infectious disease specialists, and primary care physicians.

The goal of this activity is for learners to be better able to optimize first-line management of patients with C difficile.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Evidence-based strategies for diagnosing C difficile
  • Have greater competence related to
    • Optimizing treatment selection for C difficile
    • Using antimicrobial stewardship approaches in management of C difficile


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


  • Mark H. Wilcox, MD

    Professor of Medical Microbiology
    Sir Edward Brotherton Chair of Bacteriology
    University of Leeds
    Leeds Teaching Hospitals NHS Trust
    Leeds, United Kingdom


    Mark H. Wilcox, MD, has the following relevant financial relationships:
    Consultant or advisor for: Bayer; Crestone; Da Volterra; Deinove; EnteroBiotix; Ferring; GlaxoSmithKline; Merck; Nestlé; Paion; Paratek; Pfizer; Phico Therapeutics; Qpex Biopharma; Seres; Surface Skins; Summit; Tillotts; Vedanta; Vaxxilon/Idorsia
    Speaker or member of speakers bureau for: GlaxoSmithKline; Merck; Pfizer; Seres
    Research funding from: Almirall; Da Volterra; EnteroBiotix; GlaxoSmithKline; Merck; MicroPharm; Nabriva; Paratek; Pfizer; Seres; Summit; Tillotts
    Stock options from: Seres


  • Alessia Piazza, PhD

    Medical Education Director, WebMD Global, LLC


    Alessia Piazza, PhD, has no relevant financial relationships.

  • Ashley Stumvoll, MRes

    Associate Medical Writer, WebMD Global, LLC


    Ashley Stumvoll, MRes, has no relevant financial relationships.

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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Best Practice in First-Line Management of Clostridioides difficile: Practical Patient Cases and Expert Perspectives

Authors: Mark H. Wilcox, MD Faculty and Disclosures

CME Released: 11/23/2022

Valid for credit through: 11/23/2023, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Case 1: Patient History

Jane, a 72-year-old patient, is transferred to the emergency department (ED) by her nursing home care staff. She presents with severe, watery diarrhea and appears lethargic and disoriented. Jane communicates that she feels nauseous but is unable to provide more information on her condition.

Jane's caregiver reports that Jane was recently taken on holiday to a nearby coastal village by her daughter. When Jane returned to the nursing home, she resumed her typical weekly routine of sitting with cats at the local animal rescue to provide socialization. Two weeks after returning home, Jane began to experience diarrhea that rapidly became more severe. The care staff waited 2 days to see if the symptoms would resolve before bringing her for further evaluation.

You admit Jane to hospital and begin supportive care while working on a diagnosis. Her history and physical examination findings can be found below (Tables 1 and 2).

Table 1. Patient History

History Findings
Medical Gastrointestinal reflux disease
Unstable mobility -- fall risk
Current medications Omeprazole
Allergies   None
Psychosocial   Mild cognitive impairment
Immunizations Up to date

Table 2. Physical Examination

Physical Examination Findings
Vital signs • Height 1.68 m
• Weight 49.4 kg
• BMI 18.1
• BP 100/70 mm Hg
• Heart rate 105 bpm
• Temp 39°C
General Appears lethargic and disoriented
Chest and lungs Normal
Heart Normal
Abdomen   Some pain on palpation
BMI, body mass index; BP, blood pressure; temp, temperature.
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