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Clostridium difficile Infections: Diagnosis, Treatment, and Prevention

Slide: 22 of 33

Nonstandard Interventions to Treat CDI or Reduce the Risk of Recurrence

The clinical question of interest in this part of the study was what nonstandard treatments are currently being utilized and their efficacy, particularly for recurrent CDI. Patients with relapsing or recurrent CDI are of special concern due to the demonstrated difficulty with permanent cure of the infectious organism, and are often the stated targeted patient population for nonstandard treatments. Likewise, preventing recurrence is an important clinical goal. A total of five RCTs on nonstandard adjunctive treatments of CDI and 13 studies that addressed prevention of CDI formed the basis of this analysis. The target patient population was adults with clinical signs consistent with CDI in hospital, outpatient, or long-term care settings.

Nonstandard interventions to improve a patient’s resistance to CDI or CDI recurrence included probiotics, oligofructose prebiotic, C. difficile-specific polyclonal antibody-enriched immune whey, toxin-neutralizing antibodies, toxin-absorbing resins, and intravenous immunoglobulin. Probiotics and prebiotics aim to modify the patient’s intestinal microbioecology to better resist CDI. Probiotics delivers nonpathogenic microorganisms thought to compete with or inhibit C. difficile, while prebiotics aim to promote the growth of beneficial organisms. Fecal flora reconstitution instills donor feces into the patient with CDI to normalize the intestinal flora. The procedure has been variously termed in the literature, including fecal bacteriotherapy, fecal transplantation, and donated stool. The C. difficile-immune whey is a nonantibiotic modality, which is based on orally ingested specific C. difficile-enriched bovine immunoglobulins. The toxin neutralizing antibodies are monoclonal antibodies to C. difficile toxins A and B.