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A Deeper Look at the Efficacy of Off-Label C. difficile Treatments

JAN 02, 2017 | RACHEL LUTZ
According to the researchers, tetracyclines are another option, including omadacycline, which have a considerable potency against gram-positive bacteria. Additionally, inhibitors of metabolic pathways, inhibitors of cell wall formation, agents with direct effect on cell walls and cell membranes, and hybrid antibiotics and other agents with multiple mechanisms of action are all options for future treatment as well.

Toxin neutralizing agents are another sector of possible future treatment, but they do not aim to eliminate C. difficile bacteria–instead, they intend to prevent its cytotoxic effect on colonocytes. While these agents could be used as prophylactic or concurrent therapies, they do not prevent asymptomatic carriage and transmission because of their lack of effect on the bacteria or its spores, the researchers noted.

A few C. difficile vaccines are in preclinical phases and may be soon tested in the clinical setting. However, these vaccines do not lower colonization rates, the team said.

Methods of restoration and modulation of the intestinal microbiota are also being explored as a route to protect against C. difficile infection. The research outlined that these techniques could present the most complete solution to C. difficile infection, as they are intended to achieve a clinical cure and prevent carriage, transmission and recurrence all in one. Fecal microbiota transplant is one way to do this, though more efficacious methods are being investigated, including types of bile acid therapy and intestinal antibiotic inactivators.

Anti-inflammatory options, while not exclusively anti-clostridia agents, aim to increase survival of patients who are severely ill and decrease morbidity, the study authors wrote.
“Antibiotic surveillance programs and more directed anti-clostridia antibiotics have been demonstrated to be useful, but the steadily increasing number of susceptible hosts (immunocompromised patients, elderly, etc) may prove these efforts insufficient to halt the epidemic,” the study authors concluded.
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