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Clostridium difficile Infections: Diagnosis, Treatment, and Prevention

Slide: 25 of 33

Nonstandard Interventions for Treatment of Multiple Recurrences of CDI

In one study of 38 patients who had one or more recurrences in a 3-month period, C. difficile immune whey had an overall relapse-free response rate that was similar to metronidazole. There was not a placebo arm in this study, the sample size was not achieved, and the trial ended prematurely due to the bankruptcy of the sponsor.

Another approach under investigation for treatment of recurrent or refractory CDI is fecal flora reconstitution, which instills feces from a healthy donor into the colon of a patient with CDI. Six case studies/series have been published, four within the last 2 years. Of a total of 60 patients, 52 patients (87 percent) resolved diarrhea and experienced no further relapse during followup. Two studies reported relapse of diarrhea in 7 of 34 patients (21 percent). Followup periods ranged from 3 weeks to 8 years. Overall, there is limited low-strength evidence from 6 case studies/series with 60 patients that fecal flora reconstitution is effective in treating recurrent CDI for up to 1 year.