Can We Break the Cycle of Recurrent CDI?

There is an evolution of thinking about how this is treated and investigational therapies are looking to help these patients improve not only their medical conditions but give them back their quality-of-life.


Clostridioides difficile infection (CDI) continues to be a pervasive condition with not only medical concerns, but quality-of-life issues associated with it.

Upwards of 500,000 people might have a positive CDI test annually says gastroenterologist Paul Feuerstadt, MD, which means many more people may be affected by this problem. As much as 35% of patients treated for an initial episode of CDI develop a recurrence, and up to 65% of these patients experience multiple episodes of it and it can become recurrent (r)CDI.

“Patients get caught in this vicious cycle of reoccurrence,” Feuerstadt, said during an interview at IDWeek 2022.

It is this cycle of rCDI, which can lead to medical problems long-term and a diminished quality-of-life that has clinicians concerned. Sitting down to tell a patient there is nothing they can do, and that they might have a chronic condition that could come back again can be demoralizing.

However, in rCDI, medical science has been exploring a different, more holistic treatment approach for patients with recurrent CDI according to Feuerstadt. He says patients experience a depletion of their microbiota after CDI treatment, and for some patients they struggle to grow it back. In these cases after the standard-of-care using antimicrobials, the use of a microbiota therapeutic may benefit these patients and help them to regain their own bacteria.

For example, RBX2660, is an investigational microbiota therapeutic that has been in clinical trials. Last month, the FDA's Vaccines and Related Biological Products Advisory Committee's (VRBPAC) committee voted to recommend a Biologics License Application (BLA) for RBX2660 for rCDI.

Feuerstadt spoke to Contagion who provided some insights about the persistent battle of rCDI, the data behind the phase 3 Punch trial for RBX2660, and how clinicians might utilize this therapy if it receives a final FDA approval.

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