Anti-C. difficile Toxin B Monoclonal antibody, Clone C535N

Objective: The aim of this study was to assess the pomegranate juice against the growth and toxin production of multidrug-resistant Clostridium difficile hypervirulent strain NAP1/027/BI and also against the growth of beneficial bacteria to prevent or suppress C. difficile infection (CDI). Materials and methods: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were taken as parameters for the assessment of antimicrobial property of the pomegranate juice. Four different C. difficile hypervirulent strains NAP1/027/BI, Lactococcus lactis spp., Lactobacillus casei, and Bifidobacterium animalis were subjected to the broth dilution method to determine the MIC and MBC. Enzyme-linked immunosorbent assay (ELISA) was performed to determine clostridial toxin B (TcdB) production in the presence of pomegranate juice. Results: The MIC and MBC of pomegranate juice containing punicalagin were found to be 390 mu g/mL for all C. difficile hypervirulent strain NAP1/027/BI, and the growth of L. lactis spp., L. casei, and B. animalis was not inhibited. Pomegranate juice reduced TcdB production in C. difficile hypervirulent strain NAP1/027/BI. Conclusion: This study highlights the potential of pomegranate juice to reduce CDI without affecting the beneficial bacteria. Pomegranate juice may be a useful antimicrobial agent to prevent or suppress CDI, avoiding the use of antibiotics.

Purpose of Review The goal of this review was to determine the current treatment and prevention recommendations for Clostridium difficile infections (CDI) and their efficacy. We elucidate new treatment and prevention strategies that are in development, and define populations that are at greatest risk of CDI. Recent Findings New practice guidelines recommend vancomycin or fidaxomicin as first-line treatment for CDI with oral metronidazole only being used in cases of non-severe CDI when vancomycin and fidaxomicin are not available. Metronidazole is recommended in an IV formulation in conjunction with oral vancomycin in fulminant CDI. Recurrent CDI (rCDI) may be treated with vancomycin, fidaxomicin, or fecal microbiota transplant (FMT). Recent studies show fidaxomicin and fecal microbiota transplantation to be the most effective in decreasing the risk of rCDI. Prevention of CDI is primarily through judicious use of antibiotics and strategies aimed at minimizing the spread of C. difficile spores in hospitals. New preventative options are being studied including an oral beta-lactamase that may decrease the risk of developing CDI after beta-lactam use and a potential vaccine against toxins A and B produced by C. difficile. rCDI continues to be a significant problem particularly in older populations. New treatment guidelines may provide increased protection of recurrence as new medications and treatment modalities are more often utilized. Adjunctive treatments currently being studied may provide additional protection against recurrence but prevention against initial (iCDI) is still of great importance.