The potential for emerging therapeutic options for Clostridium difficile infection

Gut Microbes. 2014;5(6):696-710. doi: 10.4161/19490976.2014.983768.


Clostridium difficile is mainly a nosocomial pathogen and is a significant cause of antibiotic-associated diarrhea. It is also implicated in the majority of cases of pseudomembranous colitis. Recently, advancements in next generation sequencing technology (NGS) have highlighted the extent of damage to the gut microbiota caused by broad-spectrum antibiotics, often resulting in C. difficile infection (CDI). Currently the treatment of choice for CDI involves the use of metronidazole and vancomycin. However, recurrence and relapse of CDI, even after rounds of metronidazole/vancomycin administration is a problem that must be addressed. The efficacy of alternative antibiotics such as fidaxomicin, rifaximin, nitazoxanide, ramoplanin and tigecycline, as well as faecal microbiota transplantation has been assessed and some have yielded positive outcomes against C. difficile. Some bacteriocins have also shown promising effects against C. difficile in recent years. In light of this, the potential for emerging treatment options and efficacy of anti-C. difficile vaccines are discussed in this review.

Keywords: ATCC, American Type Culture Collection; CDI, Clostridium difficile infection; CdtLoc, binary toxin locus; Clostridium difficile; DNA, deoxyribonucleic acid; DPC, Dairy Products Collection; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ETEC, enterotoxigenic E. coli; FDA, Food and Drug Administration; FMT, faecal microbiota transplantation; GIT, gastrointestinal tract; HIV, human immunodeficiency virus; IDSA, Infectious Diseases Society of America; IgG, immunoglobulin G; LTA, lipoteichoic acid; M21V, methionine to valine substitution at residue 21; MIC, minimum inhibitory concentration; NGS, next generation sequencing; NVB, Novacta Biosystems Ltd; PMC, pseudomembranous colitis; PaLoc, pathogenicity locus; R027, ribotype 027; RBD; RBS, ribosome binding site; RNA, ribonucleic acid; SHEA, Society for Healthcare Epidemiology of America; V15F, valine to phenylalanine substitution at residue 15; antibiotics; faecal microbiota transplantation; receptor binding domain; toxins; vaccines.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Vaccines / therapeutic use
  • Clostridioides difficile / drug effects
  • Clostridioides difficile / physiology*
  • Clostridium Infections / drug therapy
  • Clostridium Infections / microbiology
  • Clostridium Infections / therapy*
  • Humans


  • Anti-Bacterial Agents
  • Bacterial Vaccines