Clostridium difficile Infection: Current and Emerging Therapeutics

Clostridium difficile infection (CDI) has been identified as a significant threat to human health in the twenty-first century. Patients with CDI experience diarrhea, gastrointestinal pain, and colonic inflammation that can be life-threatening. Antibiotic therapy is successful at treating the majority of patients with CDI, but an increased number of CDI cases over the last 15 years, including severe and recurrent disease, is problematic and must be addressed with a multifaceted approach. Cleaning and infection prevention protocols are necessary to eradicate C. difficile spores and minimize both disease transmission and recurrent infection. Appropriate antibiotic treatment with metronidazole, vancomycin, or fidaxomicin should be selected based on consideration of the disease severity, relative cost-benefit, and likelihood of treatment failure. When antibiotics fail, treatment of severe, recurrent CDI with fecal microbiota transplantation (FMT) may be justified. While caution is warranted due to the unknown long-term side effects of FMT, clinical evidence has shown excellent patient outcomes. However, difficulties associated with the lack of a standardized, FDA-approved prescription treatment must be overcome before FMT can be considered a mainstay treatment. Surgery has a role for treatment of severe fulminant CDI which is not improving with medical management. Research and development is focused on preventing infections, improving patient outcomes, and reducing recurrent disease. C. difficile-specific antibiotics and biotherapeutic approaches such as vaccines and human monoclonal antibodies currently in phase III clinical trials offer hope for improved treatment options available in the near future.