Wide range of C difficile interventions in the works

Jun 5, 2012 (CIDRAP News) – In the future, some patients scheduled to be hospitalized may be vaccinated or receive monoclonal antibodies before admission to prevent Clostridium difficile infections, a leading expert on C difficile said today.

At a teleconference hosted by the National Foundation for Infectious Diseases (NFID), Dale N. Gerding, MD, of Loyola University in Chicago, said a wide range of prevention tools and treatments for C difficile is in various stages of development and testing.

C difficile is a bacterium that often causes intestinal disease in hospital patients after antibiotic treatment for other conditions disrupts their intestinal bacteria. The infection kills about 14,000 patients per year in the United States, according to the Centers for Disease Control and Prevention (CDC). The infections are usually treated with antibiotics, but they recur in about 25% of patients, sometimes many times, Gerding said.

He said four new antibiotics for C difficile are currently in clinical trials, along with a new formulation of metronidazole, an existing antibiotic. Also in trials are two vaccines, one monoclonal antibody, and several probiotics (bacterial preparations designed to restore normal bacterial populations in the colon), he reported.

"The use of probiotics is very common, but the evidence of efficacy is not so common," he said. A British study suggested that a probiotic drink was helpful in preventing C difficile, but the patients in the trial were "highly selected," he said. Similarly, a Chinese study showed a preventive benefit, but there are questions about its methodology.

"We know that there's something in the normal microbiota that will prevent this disease; we just need to find out what it is," he said.

In other news at the NFID event, Eliot Godofsky, MD, MS, said new recommendations on testing for hepatitis C virus infections are expected this summer from the CDC, which could lead to the identification of many people with unrecognized infections.

Godofsky, director of the University Hepatitis Center in Bradenton, Fla., said it's estimated that 4 million to 5 million Americans have hepatitis C infections and that 50% to 75% of them don't know it. The estimated overall prevalence in the general population is about 2%, but it's believed to be about 4% in baby boomers—those born between 1945 and 1965.

Testing everyone in this birth cohort would be expected to identify about 1 million people with the infection, he said. The CDC has drafted new recommendations on testing for hepatitis C, and they could be formally approved by the end of the summer, he added.

See also:

Information on the NFID news conference

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