Table 4.

Novel approaches for the treatment of Clostridium difficile infection (CDI)

Approach	Details
Antimicrobials	Antibiotics	A number of novel antibiotics are in clinical trials
	Ribaxamase	This is a beta-lactamase that may be co-administered with systemic broad-spectrum antibiotics, with the aim of degrading the antibiotics in the gut before they can affect the gut microbiota and create a propensity to CDI
Immunisation	Passive immunisation	Co-administration of bezlotoxumab (an anti-toxin B antibody) together with conventional antibiotic therapy has been shown to reduce the rate of recurrence of CDI compared to antibiotic therapy alone22
	Active immunisation	Anti-toxin vaccines are now in clinical trials. However, early data suggest reduced seroconversion in older people, those most at risk of CDI
Microbiome manipulation	Non-toxigenic C difficile23	In a clinical trial, non-toxigenic C difficile was administered to those with CDI, with the aim of outcompeting toxigenic C difficile from its reservoir within the gut. CDI recurrence rates were 30% in those receiving placebo in comparison with 11% in those receiving non-toxigenic C difficile