From the Guidelines
Bezlotoxumab (Zinplava) is the most effective medication for preventing Clostridioides difficile (C. diff) infection recurrence in high-risk patients, administered as a one-time intravenous infusion alongside antibiotic treatment. According to the most recent guidelines, bezlotoxumab can be considered for patients with other risks for CDI recurrence, including age >65 years, immunocompromised host, and severe CDI on presentation 1. The use of probiotics containing Saccharomyces boulardii or certain Lactobacillus strains may also help reduce the risk of C. diff infection, especially when taken during antibiotic treatment 1. However, the most effective prevention strategies include proper hand hygiene with soap and water, careful antibiotic stewardship, and contact precautions in healthcare settings.
Some key points to consider:
- Bezlotoxumab is recommended for high-risk patients who have had multiple recurrences of C. diff infection 1
- Probiotics may be an effective adjunct to standard antibiotic treatment in patients with at least one prior episode of CDI 1
- Fecal microbiota-based therapies, such as fecal microbiota transplant, may be considered for select patients with recurrent C. diff infection, but the use of these therapies should be guided by clinical guidelines and expert opinion 1
- The prevention of C. diff infection requires a multifaceted approach that includes proper infection control measures, careful antibiotic use, and consideration of adjunctive therapies such as probiotics and bezlotoxumab.
In terms of specific patient populations, the guidelines suggest that bezlotoxumab may be considered for patients with a history of congestive heart failure, but the benefit should outweigh the risk 1. Additionally, the use of fecal microbiota-based therapies should be avoided in severely immunocompromised adults 1. Overall, the prevention and treatment of C. diff infection require a careful and individualized approach that takes into account the patient's underlying risk factors and medical history.
From the Research
Medications for Prevention of C. diff Infection
- Vancomycin and fidaxomicin are recommended for first-line therapy for most cases of CDI, as they have been shown to be effective in preventing recurrent CDI 2, 3.
- Bezlotoxumab, a monoclonal antibody, has been shown to be effective in preventing recurrent CDI, especially when used in combination with actoxumab 4, 5.
- Fecal microbiota transplantation (FMT) has been shown to be effective in preventing recurrent CDI, with various methods of administration, including nasogastric tube and capsules 6, 3, 5.
- Probiotics, such as Bacillus clausii and Lactobacillus reuteri, may also be effective in preventing CDI, although more research is needed to confirm their efficacy 6.
Emerging Therapies
- New antibiotics, such as cadazolid and ridinilazole, are being developed and tested for the treatment and prevention of CDI 4, 3.
- Antibiotic inactivators and gut microbiota modulating therapies are also being explored as potential treatments for CDI 3.
- Bacteriophages and their derivatives, such as endolysins and tailocins, are being studied as potential therapeutic agents for CDI 4.
Prevention Strategies
- Antibiotic stewardship and infection control measures are essential components of CDI management and prevention 2, 3.
- Validated risk prediction tools are needed to identify patients most likely to benefit from preventive treatments 2.
- Combining probiotics with prebiotics may improve their efficacy in preventing CDI 6.