Clostridium difficile: new therapeutic options

Clostridium difficile disease is the major, known cause of nosocomial diarrhea and is an emerging cause of community-associated diarrhea. Recent outbreaks due to a strain of apparent increased virulence, BI/NAP1, and recognition of increasing metronidazole treatment failures as well as the morbidity associated with recurrent C. difficile disease have begun to spur studies to develop new therapies for C. difficile disease. Nitazoxanide, tolevamer, ramoplanin, and rifaximin are key agents being evaluated as new therapies for C. difficile disease. For now, vancomycin or metronidazole combined with discontinuation of antibiotics, when feasible, and expert infection control remain the mainstays of C. difficile disease management.