Clinical implications of antibiotic impact on gastrointestinal microbiota and Clostridium difficile infection

ABSTRACT

The human gastrointestinal (GI) microbiota plays an important role in human health. Anaerobic bacteria prevalent in the normal colon suppress the growth of non-commensal microorganisms, thus maintaining colonic homeostasis. The GI microbiota is influenced by both patient-specific and environmental factors, particularly antibiotics. Antibiotics can alter the native GI microbiota composition, leading to decreased colonization resistance and opportunistic proliferation of non-native organisms. A common and potentially serious antibiotic-induced sequela associated with GI microbiota imbalance is Clostridium difficile infection (CDI), which may become recurrent if dysbiosis persists. This review focuses on the association between antibiotics and CDI, and the antibiotic-induced disruption leading to recurrent CDI. Promoting antibiotic stewardship is pivotal in protecting native microbiota and reducing the incidence of CDI and other GI infections.

KEYWORDS:

• Clostridium difficile infection
• microbiota
• microbiome
• antibiotics
• stewardship
• antibiotic-associated diarrhea
• Clostridium difficile associated diarrhea

Acknowledgments

Medical writing assistance was provided by Teresa Tartaglione, PharmD. Editorial assistance was provided by Dan Rigotti, PhD, and Cara L. Hunsberger of StemScientific, Lyndhurst, NJ, an Ashfield Company, part of UDG Healthcare plc, and by Paul O’Neill, PhD, of Complete Medical Communications, Glasgow, UK. This assistance was funded by Merck and Co., Inc., Kenilworth, NJ.

Financial & competing interests disclosure

S Khanna has served as a consultant in the past to Optimer Pharmaceuticals (now Merck Pharmaceuticals). S Khanna serves as a consultant to Rebiotix Inc. DS Pardi serves as a consultant to Merck Pharmaceuticals and Seres Therapeutics. 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.