What Therapy is Most Effective Against C. Diff?
Adding which therapy to the standard antibiotic treatment of Clostridium difficile infection is most effective in preventing recurrent infection?
a. bezlotoxumab
b. actoxumab
c. bezlotoxumab plus actoxumab
d. all are equally effective
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Answer: a
Adding the human monoclonal antibody bezlotoxumab to the standard antibiotic treatment of Clostridium difficile infection (CDI) prevents about 40% of infections from happening again, according to new research. The international study involved 2,655 patients who were treated with the antibiotics metronidazole, vancomycin, or fidaxomicin for primary or recurrent CDI. The patients were randomly assigned to receive single doses (at 10 mg/kg of body weight) of actoxumab, bezlotoxumab, bezlotoxumab plus actotoxumab, or a saline placebo.
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According to the findings, recurrent CDI occurred in 26% of patients who received actoxumab, 17% who received bezlotoxumab, 15% who received bezlotoxumab plus actotoxumab, and 27% who received placebo. Combining actoxumab with bezlotoxumab provided no extra clinical benefit and was associated with more adverse events, according to lead researcher Dr. Mark Wilcox, a professor of medical microbiology at the University of Leeds in the Untied Kingdom (N Engl J Med. 2017;376[4]:305-317).
The U.S. Food and Drug Administration (FDA) approved bezlotoxumab injection in October 2016 for the prevention of recurrent CDI in patients on antibacterial drug treatment. These findings represent the final clinical and regulatory hurdle to establishing the efficacy and safety of a new treatment option of CDI, for which there very few effective alternatives, said Dr. Wilcox. He added that approximately 1 in 4 patients with CDI experience a recurrence after standard antibiotic treatment, and noted those repeat infections are difficult to treat, have severe outcomes, and are associated with more hospitalizations. Providers should now consider which patients on antibiotics for the treatment of CDI would benefit from the addition of bezlotoxumab, according to Dr. Wilcox. He said the antibody is particularly effective in patients with risk factors for poor outcomes, including older age, immunocompromise, and severe infection.
