Alternative treatments for Clostridium difficile disease: what really works?

Abstract

Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

Probiotics for recurrent Clostridium difficile disease

“…Our study findings complement another small-scale trial that reported no benefit from a yogurt formulation of adjunctive LGG (Pochapin, 2000;McFarland, 2005). Although our study was not powered to detect a difference in outcomes for RCDAD, the data spotlight several feasibility challenges relevant to the launch of a large-scale probiotic efficacy trial.…”

“…Although our study was not powered to detect a difference in outcomes for RCDAD, the data spotlight several feasibility challenges relevant to the launch of a large-scale probiotic efficacy trial. First, the majority of participants were prescribed concurrent systemic antimicrobial therapy for non-CDAD indications and gastric acid suppressive therapy, both of which interfere with the normal gut flora and its ability to inhibit C. difficile colonization (McFarland, 2005;Dial et al, 2004). Avoidance of these drugs is often not feasible in frequently hospitalized older adults with multiple comorbidities, thus introducing an important source of confounding that can be difficult to quantify.…”

“…In this journal's recent review of Clostridium difficile-associated disease (CDAD) management, McFarland (2005) emphasized the need for definitive efficacy trials to test recurrent CDAD (RCDAD) therapies. To address this recommendation, we report results and feasibility issues learned from a pilot trial of adjunctive Lactobacillus rhamnosus GG (LGG) for prevention of RCDAD.…”

Recurrent Clostridium difficile infection and the microbiome

“…While most patients experience clearance of C. difficile with antibiotic therapy (metronidazole or vancomycin), approximately 20 % will experience another episode of CDI within 180 days of discontinuing antibiotics [31]. Multiple recurrence is seen in over half of patients who experience their first relapse and can range as high as 40-65 % in those previously treated for rCDI [31].…”

Esporas de Clostridium difficile y su relevancia en la persistencia y transmisión de la infección

“…Durante el curso clínico de la IACD se ha observado un importante aumento de la cantidad de esporas excretadas por las deposiciones 2,70,71 , indicando que C. difficile esporula dentro del tracto intestinal, contribuyendo a la persistencia dentro del hospedero (Figura 2). La resistencia de las esporas de C. difficile a los antimicrobianos es tal, que éstas pueden persistir después de un curso terapéutico de metronidazol y vancomicina 72 .…”