Expert Perspectives on Advances in the Management of C. Difficile - Episode 14

Preventing/Treating C. Difficile: Unmet Needs

Peter L. Salgo, MD: We talked about newer agents for the treatment of CDI [Clostridioides difficile infection]. To me, fidaxomicin sounds new, but I’m not a person on the front lines treating this. Bezlotoxumab is definitely new. Do we need even newer agents for treating CDI? Is what we have enough, or is there something new out there, Teena Chopra, MD, MPH, that we really want and need that’s in the pipeline?

Teena Chopra, MD, MPH: I think we discussed this briefly; we definitely need newer agents. We know that the big hole and the big gap in the epidemiology of C diff is recurrent C diff still. We want newer treatments which are targeted towards microbiome which are microbiome-sparing, due to C diff remaining an urgent threat to public health in general. This is something that Paul Feuerstadt, MD, FACG, AGAF had very nicely explained; the colonization resistance in our microbiome is extremely important.

We have talked about these newer therapies that are sparing the microbiome much better, especially newer agents that are sparing the microbiome. We have talked about fecal transplantation and other drugs that are available. We want to make sure that we have a lot of diversity in our gut microbiome. This diversity decreases as we age, and it also is very low in patients who have recurrent C diff. Like Paul Feuerstadt, MD, FACG, AGAF talked about the second punch, sometimes recurrent C diff patients cannot overcome this colonization resistance; it is just a point of no return for them. There is definitely a need for newer therapies, and not only research around microbiome but also metabolome because there is metabolic changes in our gut microbiome that also are affected as we get more recurrent episodes of C diff.

Peter L. Salgo, MD: If you enjoyed this content, you should subscribe. We have an e-newsletter, and you can receive upcoming Peer Exchanges and other great content in your inbox—that’s right, electronically. I’ll see you next time. I’m Dr. Peter Salgo. Thanks again for watching.

Transcript Edited for Clarity