Astha Saini DO and Lea M Monday PharmD MD*
Clostridioides difficile infection (CDI) poses significant healthcare costs and morbidity due to its high recurrence rates. Reductions in gastrointestinal microbiome species heterogeneity from antibiotics or other causes result in a loss of colonization resistance that sets the stage for CDI. Antibiotics including vancomycin and fidaxomicin are the standard of care for primary and recurrent non-fulminant CDI (rCDI). Regardless of antibiotic choice, the likelihood of rCDI increases after each episode, and novel treatments are needed to prevent further recurrences. Microbiome research has led to the development of live biotherapeutic products (LBPs) to restore GI colonization resistance and break the cycle of rCDI. While derived from human stool, LBPs differ from fecal microbiota transplant (FMT) and one another. These agents vary in bacterial composition, manufacturing methods, administration routes, and other factors. The Food and Drug Administration has approved two LBPs to prevent rCDI and other LBPs remain in various stages of clinical development. These agents are an exciting addition to the options for preventing rCDI; however, questions remain. This review aims to summarize the development of LBPs and explain how they differ from FMT, explore their clinical utility for preventing rCDI, and address future perspectives and unanswered questions.
Published Date: 2024-04-23; Received Date: 2024-03-26
