Dale Gerding, MD: Promising C Difficile Treatments & Preventions

The landscape of treatment approaches and preventative practices for C difficile is widespread diverse. With new developments, such as vaccines and fecal transplants making strides, patients and physicians are gaining more options than ever before.

While at the 6th International C diff Awareness Conference and Health EXPO in Philadelphia, Pennsylvania, Dale Gerding, MD, research physician of infectious diseases at Edward Hines, Jr. Veterans Affairs Hospital, spoke with MD Magazine® about the newest and most promising treatment approaches and preventions for C difficile.

Interview transcript (modified slightly for readability):

MD Magazine®: What are the newest and most promising treatment approaches and preventions?

“That's a good question. It's hard to know what to say is most promising because there are immunologic approaches that are already there with monoclonal antibodies that actually provide additional prevention of recurrence.

Vaccines are in development. They may ultimately be the way that we provide long-term prevention, but, also very promising are things like microbiome replacement, or sometimes called fecal transplant technologies, which either can be derived directly from donor feces and either provided as a preparation that can be given by enema or by colonoscopy, or—and this is the direction all of this is going—either gliflozin frozen or put into capsules.

These capsule approaches are going to be much more practical and much more acceptable by patients [by] avoiding having to have anesthesia for a colonoscopy—for example—or even a bowel prep for colonoscopy, which for those who have had a colonoscopy know, the bowel prep is the worst part of the whole procedure.

Then, there are other approaches to prevention that look like they might be effective when antibiotics are administered to patients, and 1 of them is a beta lactamase that actually prevents this destruction of the microbiome by the drug in the gut. That can be used with beta-lactam antibiotics. There's also an activated charcoal preparation that is under investigation that will tie up the drug in the colon so that the microbiome is not affected.

In something called nontoxigenic C difficile, which I work on extensively, actually just replaces the pathogen in the toxigenic C difficile with a nontoxigenic strain that is harmless, and when that's present, it keeps out toxic strains of C difficile.”