I frequently tell families that Clostridium difficile is the ‘Forrest Gump’ of bacteria; it tends to do well when its competitors are decimated. One of the problems with Clostridium difficile infection (CDI) has been recurrence. This occurs in part because after treatment of CDI the microbiota of the host remains vulnerable to recurrence. This has been one of the rationales behind the use of probiotics. However, probiotics have not been very effective. As such, more research has been directed in this area. This includes a recent study (Gerding DN et al. JAMA 2015; 313: 1719-27) which showed that administration of spores of nontoxigenic Clostridium difficile can prevent recurrent CDI.
While fecal microbiota transplantation (FMT) has been very effective in treating CDI, there is definitely a yuck factor. In addition, more targeted therapy is desirable. In this study, the authors enrolled 173 patients (157 completed treatment) at 44 study centers as part of a phase 2, randomized, double-blind placebo-controlled, dose-ranging study. After completion of antibiotics (metronidazole or vancomycin), participants received 1 of 4 treatments with a nontoxigenic C difficile strain M3 (NTCD-M3).
- Recurrence of CDI were reported in 14 (11%) of NTCD-M3 patients compared with 13 (30%) placebo patients.
- 69% of NTCD-M3 patients were colonized. Recurrence in this group (n=86) occurred in 2 (2%) compared with 12 (31%) of NTCD-M3 non-colonized patients.
- Fewer adverse events were noted in NTCD-M3 group compared with placebo patients with serious events occurring in 3% and 7% respectively.
Bottomline: These nontoxigenic oral spores of NCTD-M3 were well-tolerated and significantly reduced the risk of recurrent CDI.
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