Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance

Abstract

Clostridium difficile infection (CDI) is the most common cause of identifiable diarrhea in hospitalized patients. The incidence and severity of CDIs are increasing. The increased incidence and severity of the disease has sparked interest in the optimal treatment of CDI as well as the use of new therapies and drug discovery. Current treatment strategies are inadequate with decreased response rates to metronidazole, and high recurrence rates with the use of metronidazole and oral vancomycin. Although incidence rates continue to be low, in vitro resistance to antibiotics used for the treatment of CDI has been noted. Recently, important data has emerged on new anti-C. difficile antibiotics such as rifaximin, rifalazil, fidaxomicin, nitazoxanide, tigecycline and ramoplanin. The purpose of this review is to provide an update on the in vitro susceptibility and new antibiotic treatment options for CDI. This review will focus primarily on scientific studies published in the last 36 months in order to provide an up-to-date review on the topic.

Keywords::

• Clostridium difficile
• fidaxomicin
• nitazoxanide
• rifaximin
• treatment update

Acknowledgements

The authors would like to thank the St Luke’s Episcopal Hospital CDI task force members Layne O Gentry, Mark A LaRocco and Margaret F Price and the trainees at the University of Houston, College of Pharmacy and the University of Texas, Houston School of Public Health: Vaneet Arora, Shannon Baker, Adam Connelly, David DeBlois, Kplola Elhor Gbito, Shashank Ghantoji, Quynh-Giao, Sumesh Kachroo, Vishal Kaila, Michelle Lee, Andrea Mora, Lacey Mullins, Ngoc Nguyen, Keyur Patel, Rena Patel, Thai Thanh Phan, Ricky Rodrigue, Cary Rogers, Kavita Sail, Saurabh Sethi, Nipam Shah, Beenish Shaik, Will Tipping, Christine Wong, Keith Wong, Nedayka Wright and Yashoo Yadav.

Financial & competing interests disclosure

Herbert L DuPont has received honoraria for speaking for the following companies: Salix Pharmaceuticals, Merck Vaccine Division, McNeil Consumer Healthcare, Romark Institute for Medical Research, Merck Vaccine Division and IOMAI Corporation, and has received grants through the University of Texas to support research from: Salix Pharmaceuticals, Romark Institute for Medical Research and IOMAI Corporation and Optimer Pharmaceuticals. Kevin W Garey has received grants to support research from Salix Pharmaceuticals and Viropharma, Inc. Zhi-Dong Jiang has received honoraria for speaking for Salix Phamaceuticals and has received grants to support research from Salix Pharmaceuticals. Hoonmo L Koo has received grant support from the National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK084513-01). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.