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Nat Rev Gastroenterol Hepatol. 2016 Mar;13(3):150-60. doi: 10.1038/nrgastro.2015.220. Epub 2016 Feb 10.

Breakthroughs in the treatment and prevention of Clostridium difficile infection.

Author information

1
Ann &Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, Illinois 60611, USA.
2
Edward Hines, Jr Veterans Affairs Hospital, 5000 S. 5th Avenue, Building 1, Room 347, Hines, Illinois 60141, USA.

Abstract

This Review summarizes the latest advances in the treatment and prevention of Clostridium difficile infection (CDI), which is now the most common health-care-associated infection in the USA. As traditional, standard CDI antibiotic therapies (metronidazole and vancomycin) are limited by their broad spectrum and further perturbation of the intestinal microbiota, which result in unacceptably high recurrence rates, novel therapeutic strategies for CDI are needed. Emerging CDI therapies are focused on limiting further perturbation of the intestinal microbiota and/or restoring the microbiota to its pre-morbid state, reducing colonization of the intestinal tract by toxigenic strains of C. difficile and bolstering the host immune response against C. difficile toxins. Fidaxomicin is associated with reduced CDI recurrences, and other emerging narrow-spectrum CDI antibiotic therapies might eventually demonstrate a similar benefit. Prevention of intestinal colonization of toxigenic strains of C. difficile can be achieved through restoration of the intestinal microbiota with faecal microbiota transplantation, as well as by colonizing the gut with nontoxigenic C. difficile strains. Finally, emerging immunological therapies, including monoclonal antibodies and vaccines against C. difficile toxins, might protect against CDI and subsequent CDI recurrences. The available clinical data for these emerging therapies, and their relative advantages and disadvantages, are described.

PMID:
26860266
DOI:
10.1038/nrgastro.2015.220
[Indexed for MEDLINE]

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