Current treatments for recurrent Clostridium difficile infection

Abstract

Introduction. Clostridium difficile infection most commonly manifests in patients with antibiotic-associated diarrhea, ranging from very mild to severe pseudomembranous colitis. Recurrent C. difficile infections remain a serious clinical problem, occurring in approximately one in five patients. Recurrence of infection despite antibiotic therapy is often due to disruption of the intestinal microbiota. Objective The aim of this review is to summarize knowledge of current treatments and explore new therapies for Clostridium difficile infection, excluding vaccines under development and bacteriophage therapy, with a particular focus on patients with recurrent infections. Review Methods. The review is based on 59 articles on the pathophysiology, epidemiology and treatment of clostridium difficile infections found in PubMed databases published between 2009–2024. Brief description of the state of knowledge. Current treatments are mainly based on antibiotic therapy, or, for severe antibiotic-resistant forms, the faecal microbiota transplantation (FMT) method. In patients with recurrent infections, prolonged antibiotic therapy or sequential therapy with vancomycin and rifaximin is used. FMT is suggested for second or subsequent recurrent infections. Hopes are pinned on oral microbiome preparations, antibodies, new antibiotics, non-toxic strains or antibiotic degraders. Summary. The treatment of recurrent infections is a difficult problem that requires a broader view. Emerging therapies with promising results focus both on antibiotic therapy that eliminates toxin-producing bacteria, and on modifying the microbiota and reducing the conversion of spore forms of these bacteria into toxin-producing forms.