Biologic Drug Plus Antibiotics Reduces Recurrent Clostridium Difficile Infections

Adding bezlotoxumab to C. difficile treatment reduce recurrent infections nearly 40%.

Findings from a new study suggest that a biologic drug, in addition to a course of antibiotics, could reduce recurrent Clostridium difficile infections up to 37%.

C. difficile is a common cause of diarrhea in patients who are staying in the hospital. These infections are largely caused by exposure to antibiotics that disrupt gut bacteria, and can sometimes be fatal. Recurrent infections are also common, and can cause serious adverse events.

“About one in four patients who have been treated with antibiotics for an initial C. diff infection will go on to have a repeat infection,” said study lead author Mark Wilcox, MD.

The authors of a study published by the New England Journal of Medicine found that adding bezlotoxumab to antibiotic treatment can reduce recurrent C. difficile infections by 37%. This human monoclonal antibody offsets a toxin produced by bacteria that damages the wall of the gut.

“These repeat infections are more difficult to treat, have more severe outcomes for the patient, and are associated with more hospitalisations [sic]. It is important to treat the first episodes of C. diff infection optimally, as each recurrence increases the chance of another episode even more,” Dr Wilcox said. “Fewer recurrent infections would mean less need to use antibiotics, fewer hospital admissions, reduced costs for the NHS and possibly a reduction in deaths.”

There were 2655 adults from around the world included in the study. All patients included had primary or recurrent C. difficile infections and were receiving treatment with metronidazole, vancomycin, or fidaxomicin.

Patients were randomly assigned to receive a dose of actoxumab, a dose of bezlotoxumab, a dose of bezlotoxumab plus actotoxumab, or placebo. Once patients were cured of the initial infection, they were followed up with for 12 weeks.

The authors found that 26% of patients treated with actoxumab developed a recurrent C. difficile, while only 17% of patients treated with bezlotoxumab developed an infection, according to the study.

In the combination treatment group, 15% developed a recurrent infection, and 27% of patients in the placebo group developed another C. difficile infection.

These findings suggest that including bezlotoxumab in C. difficile treatment regimens could decrease the number of recurrent infections, and reduce costs related to avoidable hospitalizations.

“Doctors should now consider which patients could best benefit from use of bezlotoxumab,” Dr Wilcox concluded. “The studies showed that bezlotoxumab was particularly effective in those patients with risk factors for poor outcome, including older age, immunocompromise, and severe infection.”