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Clostridium difficile, is spore-forming gram positive infected bacteria lead to diarrhea and colitis. Prognosis of serious cases can manifested in pseudomembranous colitis, septicemia, and mega colon multi-organ failure. A half-million people were infected each year according to CDC estimation [1]. The abuse of oral antibiotic, a weak immune body and recent hospitalizations are the main risk factors for C. difficile [1,2].

The fecal-oral route, airborne environmental dispersal in hospitals and hand to hand contact will to spread on of C. difficile spores.

With extended mono antibiotic or combined antibiotics use along with chemotherapy, gastrointestinal surgery, and use of acidsuppressing medications like proton pump inhibitors or histamine-2 blockers further increase of CDI symptoms developing [3]. Symptoms of CDI include The diarrhea with loose watery stools, fever, frequent bowel movement, loss of appetite, pain, nausea for several days are early symptoms of infected CDI case. The suppression of normal bowel microbiota by intake of macrolide antibiotics including clindamycin, cephalosporins, penicillins, and fluoroquinolones will allow C difficile to flourish [4]. C. difficile producing toxin A, is more potent which results in diarrhea and colitis.

Diagnosis of CDI patients was done via stools samples [4]. The oral administration of Vancomycin is minimally systemically absorbed to achieve higher concentrations in the colon. The abdominal pain, dysgeusia, nausea, headache and flatulence are the recommended adverse effects [5,6]. 20 cases of young ages (8-14 years old) with diagnosed CDI were treated with oral FIRVANQ™ (vancomycin), in dose regimen of 40mg/kg in multiple divided doses for 7 to 10 days with maximum does not exceed 2g [7-9]. Metronidazole as a pioneer momotherapy choice is used in combination with vancomycin indose regimen of 500mg metronidazole 3 times daily by mouth for 10 days [4,10]. The vancomycin concentration after reconstitution solution was 50mg/ml.

All patients were given paracetamol infusion together with the dextrose-saline in recommended doses for fever control and to avoid dehydration symptoms.

The clinical pharmacist can play considerable guide in trending treatment protocol of infectious disease by the proper prescription of antibiotic to alleviate patient risk through in hospitals and educated patient to depend on appropriate personal hygiene in pandemic health crisis to avoid outbreak of CDI [5,6]. In moderate to severe initial episode of CDI, oral vancomycin is to be first line of therapy over the injectable route to improve the recovery time with support of pharmacokinetic properties of oral preparation.

• For Techomedico lab for their assistance of CDI stool samples (State of Kuwait).

• For Generous gifts of (FIRVANQ™), manufacturer, Cutispharma, USA by my dear colleague, the pharmacist, Dr. NA Al-Qoriashi (State of Dubai).