#Probiotics, #antibiotics, #FMT, and other #microbiome therapies in C. difficile with @DrPaulGastro
@AmCollegeGastro #ACG2021
Spore phase is resistant to gastric acid and alcohol-based hand sanitizers.
A healthy #microbiome protects against the development of CDI
Antimicrobials targey the vegetative phase, and microbiome therapies target spore phase
Guidelines recommend AGAINST #probiotics for CDI prevention or treatment. BUT, strain specificity matters. A future for S. boulardii?
Narrow spectrum antimicrobials SPARE the endogenous #microbiome.
Vancomycin is too broad spectrum to allow our microbiota to knock out all the C. diff!
Fidaxomicin is noninferior to vanc for treatment, BUT fidaxomicin is SUPERIOR in terms of preventing recurrence
Ridinilazole is in clinical trials still, but seems to beat vancomycin!
Keep your 👁 out for phase III data!
Bezlotoxumab for prevention of rCDI: MODIFY 1 & 2
#FMT for CDI
Meta-analysis: #FMT probably has efficacy of closer to 70%
We are refining #FMT in CDI.
Broad consortium and narrow spectrum products are being actively studied
RBX-2660: Broad consortium, rectally administered
SER-109: made of firmicutes spores
Why was phase II data weak? They used PCR testing 😂
Look at phase III with ACTUAL CDI: 89% efficacy!
CP101 is a capsule given for a single day after treatment with antibiotics
Phase III coming
VE303 is narrow consortium, met phase II endpoint.
Look out for phase III!
From #FMT to more refined therapies.
Here is @DrPaulGastro's CDI algorithm
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