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Clostridium difficile: biological therapies

Martin, Jessicaa,b; Mawer, Damiana; Wilcox, Mark H.a,b

Current Opinion in Infectious Diseases: October 2013 - Volume 26 - Issue 5 - p 454–460
doi: 10.1097/01.qco.0000433319.82618.8f
GASTROINTESTINAL INFECTIONS: Edited by Nicholas J. Beeching and A. Clinton White

Purpose of review Biological therapies for Clostridium difficile infection (CDI) include probiotics and faecal microbiota transplant (FMT). There is significant interest in their use in treating refractory/recurrent CDI. This review summarizes the latest evidence for these approaches.

Recent findings The small number of randomized controlled trials (RCTs) using probiotics in CDI have produced variable results; the most recent showed no benefit in preventing disease. However, several meta-analyses published in the last year have suggested benefit in their use, but these conclusions are limited by the poor quality of many of the primary studies, and lack of standardization of the probiotic administered. In contrast, FMT appears highly effective for the treatment of CDI. In the only published RCT, the cure rate was 81%, which is close to the rate shown by meta-analyses of previous case series. The use of artificially produced bacterial mixtures in place of faecal samples is now under investigation.

Summary Biological therapies for CDI, especially FMT, will continue to attract attention. Further, large-scale RCTs are required to identify which patients are most likely to benefit from these therapies in the future.

aDepartment of Microbiology, Leeds Teaching Hospitals NHS Trust

bLeeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK

Correspondence to Professor Mark H. Wilcox, Department of Microbiology, Old Medical School, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. Tel: +44 113 3926818; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.