The Power of Knowledge: Patient Education Is a Tool in Preventing C difficile Recurrence

Pharmacy Times^® interviewed Bruce E. Hirsch, MD, infectious disease physician, Northwell Health; assistant investigator, Institute of Health System Science, Feinstein Institutes for Medical Research; and assistant professor, medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, on the breakout session discussion titled “How to Provide Patient Education” at the Peggy Lillis Foundation's 2025 C diff Summit in Washington, DC.

Pharmacist speaking to a patient about treatment options. Image Credit: © Nottenaj - stock.adobe.com

Hirsch emphasized the critical role of patient education in preventing and treating Clostridioides difficile (C difficile) infections. He highlighted how empowering patients with knowledge improves medication adherence and helps them recognize symptoms and recurrence risks.

Hirsch also addressed the importance of the gut microbiome, the effects of antibiotics, and the distinct nature of C difficile as a toxin-induced colitis with systemic symptoms. Hirsch also underscored the value of microbiome-supportive strategies, such as fermented foods and fiber, and emerging therapies that restore gut health.

Pharmacy Times: What is the role of patient education in C difficile prevention and treatment?

Bruce E. Hirsch, MD: Patient education and support really makes a difference. 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.

Pharmacy Times: What was discussed in the patient education breakout session at the Peggy Lillis Foundation's 2025 C diff Summit?

Hirsch: In our session that we were talking about this morning, we were talking about a number of different things. We're talking about diagnosis and about patients standing up for themselves, we were talking about the variety of presentations that different individuals have [with] different ranges of symptoms with their [C difficile] experience, but there's a lot of varieties and each person is different.

As we were talking about patient education, some of the points that were emphasized was the fact of the concept of the microbiome, the idea that our own gut bacteria are important in maintaining general health and general resilience against [C difficile], and the role of antibiotics in injuring and suppressing the gut microbiome and making individuals vulnerable to [C difficile].

We were talking about the fact that [C difficile] in the way it causes illness, is as a toxin-associated colitis and the inflammation, not invasion like with other infections, but the way that it causes a toxic colitis, causing not just diarrhea, but all the systemic toxicity and systemic symptoms that C diff is not a diarrhea to be embarrassed about. [C difficile] is an illness that can affect the entire body.

We talked about the importance of recognizing the vulnerability to our recurrence and what to anticipate and the signs and the symptoms of [C difficile]. In our patient education session, we were talking about the very specific, peculiar, awful smell that [C difficile] is associated with. [C difficile] has this metabolic product. It's called p-cresol, and it's very, very recognizable in patients who've had [C difficile], [both] in themselves and [by] their family members, [who] will often be able to comment that that smell is back and be able to suspect a [C difficile] recurrence.

Pharmacy Times: How might the microbiome impact treatment outcomes for C difficile, and what should pharmacists know for patient education purposes?

Hirsch: Well, we do know that the microbiome is markedly injured in [C difficile], and patients who have recurrent [C difficile] have even a greater magnitude of dysbiosis, and that seems to be a factor. Some of the new therapies, the live biotherapeutic products, seem to be effective in reducing the vulnerability to having [C difficile].

I think educating patients about the fact that there are treatments that are directly designed to restore and reconstitute the microbiome makes sense. In my practice, I've been advising patients to take probiotic-containing foods, fermented foods such as kefir, which has some literature behind it. In my practice, I've been discussing gradual increase of fiber intake when they're up for it, to be able to support the microbiome, and to try to support restoration of the microbiome in an effort to prevent recurrence.