C.the DIFF?

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Investigating CDI
Antibiotics paradox
Treatment advances
Stay up to date

Investigating CDI

Antibiotics paradox

Treatment advances

Stay up to date

*Clostridioides difficile (C. diff) infection.

**A C. diff infection can occur in 2 different ways**

Primary C. diff infection (pCDI)
is when an individual tests positive for
C. diff infection, without a recent
positive test (within 8 weeks)⁵

6 to 11^%

MORTALITY

30-day mortality rates⁴

Recurrent C. diff (rCDI)
is when a C. diff infection occurs within
8 weeks of a previous infection^6-9

16 to 39^%

MORTALITY

Escalation in death rate in the US after each
subsequent C. diff infection, annually⁴

Sepsis |
Toxic
megacolon |
Death

Severe diarrhea

Fever

Abdominal pain

Nausea

The standard of care for
treating primary C. diff
infection is antibiotics,
which is sufficient for
many patients,¹⁰ but …

The risk of a second recurrence of C. diff infection
increases significantly after the first^4,7,11

Hospitalizations |
Hospital days |
Clinical
complications
| Surgery

Health-related
quality of life

Physical and
psychological
impact

Work and
daily life
disruptions

Total healthcare
costs

The typical antibiotics used to treat
primary C. diff infection are¹⁰:

Vancomycin a glycopeptide antibiotic

Fidaxomicin a macrolide antibiotic

In clinical trials,
antibiotics addressed
acute symptoms
of a
C. diff infection, but many
patients experienced a
recurrent infection.¹⁵

28 to 43^%

Patients suffered a recurrence
25 days POSTTREATMENT

Antibiotics-driven dysbiosis creates an
environment susceptible to recurrence^4,9,17,18

Toxin-producing
C. diff bacteria

C. diff spores

Beneficial
bacteria

C. diff-specific
antibiotics

ABX, antibiotics.

Microbiome Key

Toxin-producing
C. diff bacteria

C. diff spores

Beneficial
bacteria

C. diff-specific
antibiotics

ABX, antibiotics.

Antibiotics alone don't address the underlying dysbiosis or the entire
2-phase life cycle of C. diff, and the risk of recurrence continues with increased frequency and patient impact^9,14,18

Antibiotics cannot eliminate the highly resilient C. diff spores, which continue to thrive in the gut without the presence of counterbalancing beneficial gut bacteria.^9,18

rCDI presents a unique clinical challenge because of the
paradox of antibiotic treatment on the primary C. diff
infection, which may lead to continued disruption of the gut
microbiome¹⁸

Antibiotic treatment is necessary to address the acute infection, but it can contribute
to the onset of a recurrent C. diff infection.

Antibiotics

Additional
therapy

Target:
improvement of
gut microbiome

The 2022 SHEA and IDSA guidelines included
antimicrobial stewardship as an essential practice
in the fight against C. diff infection.²¹

IDSA, Infectious Diseases Society of America; SHEA, Society for Healthcare Epidemiology of
America.

Experimental (non-FDA approved)
fecal microbiota transplants (FMTs)

These treatments transfer fecal material via enema or
colonoscopy.^18,22,23

FMT treatments are investigational and not widely
available.^24,25

The effectiveness of FMTs varies greatly based on a
range of factors: donor-related factors, such as previous
antibiotic prescriptions, stool consistency, or donor age;
recipient-related factors, including the patient’s genes
and immune state; and procedure-related factors, such as
timing and route of administration. Long-term risks of
FMTs are still being evaluated. The appearance of novel
viruses, such as COVID-19, raises additional concerns.^26-28

Gut microbiome therapies

A new FDA-approved class of gut microbiome therapy
products, which can be delivered either orally or rectally,
have been developed to prevent recurrent C. diff infection
when used following antibiotics.²³

Read about the only orally administered
biotherapeutic option.

Learn more about a rectally administered
biotherapeutic option.

The American Gastroenterological Association 2024 guidelines recommend
the use of these therapies to prevent recurrent C. diff infection, including
fecal microbiota live-jslm and fecal microbiota spores live-brpk.³⁰

FDA, US Food and Drug Administration.

Primary and recurrent *C. diff** infection may seem similar, but one presents a different level of risk for your patients.^1-4

Primary and recurrent *C. diff** infection may seem similar, but one presents a different level of risk for your patients.^1-4

The CDC classified C. diff infection as a top 3
public health priority that requires urgent and
aggressive action due to⁵:

**A C. diff infection can occur in 2 different ways**

Primary C. diff infection (pCDI) can lead to several complications, including life-threatening symptoms⁴:

The risk of a second recurrence of C. diff infection
increases significantly after the first^4,7,11

**The clinical, economic, and emotional consequences of recurrent C. diff infections are significant^2,4,8,12,13**

Antibiotics are the standard of care for
primary C. diff infection, but they could
contribute to a recurrent C. diff infection^4,14

**Specific antibiotics are the standard of care for treatment of active C. diff infection**

The typical antibiotics used to treat
primary C. diff infection are¹⁰:

Dysbiosis, an imbalance in the microbiome with low microbial diversity, may be exacerbated by repeated use of antibiotics, creating a window of vulnerability^9,16,17

Antibiotics-driven dysbiosis creates an
environment susceptible to recurrence^4,9,17,18

Antibiotics alone don't address the underlying dysbiosis or the entire
2-phase life cycle of C. diff, and the risk of recurrence continues with increased frequency and patient impact^9,14,18

**Addressing dysbiosis when treating recurrent C. diff infections can require a multimodal treatment strategy^{9,14,16,18-20}**

rCDI presents a unique clinical challenge because of the
paradox of antibiotic treatment on the primary C. diff
infection, which may lead to continued disruption of the gut
microbiome¹⁸

The latest treatment goals focus on addressing the
underlying dysbiosis (ideally at first recurrence), which
can contribute to the vicious cycle of C. diff infections¹⁸

Advances in microbiome science are leading to a new treatment paradigm of cointervention therapies¹⁸

The 2022 SHEA and IDSA guidelines included
antimicrobial stewardship as an essential practice
in the fight against C. diff infection.²¹

The newest treatment modalities could influence
future guideline updates, but some challenges remain

Experimental (non-FDA approved)
fecal microbiota transplants (FMTs)

Probiotics

Gut microbiome therapies

The American Gastroenterological Association 2024 guidelines recommend
the use of these therapies to prevent recurrent C. diff infection, including
fecal microbiota live-jslm and fecal microbiota spores live-brpk.³⁰

These new therapeutic options greatly expand the tools healthcare practitioners have in the important fight to reduce recurrent C. diff infection morbidity and mortality at the first sign of recurrence.¹⁸

Stay up to date on the latest
therapeutic advancements for your
patients with recurrent C. diff
infections.

Primary and recurrent C. diff* infection may seem similar, but one presents a different level of risk for your patients.1-4

Primary and recurrent C. diff* infection may seem similar, but one presents a different level of risk for your patients.1-4

The CDC classified C. diff infection as a top 3 public health priority that requires urgent and aggressive action due to5:

A C. diff infection can occur in 2 different ways

Primary C. diff infection (pCDI) can lead to several complications, including life-threatening symptoms4:

The risk of a second recurrence of C. diff infection increases significantly after the first4,7,11

The clinical, economic, and emotional consequences of recurrent C. diff infections are significant2,4,8,12,13

Antibiotics are the standard of care for primary C. diff infection, but they could contribute to a recurrent C. diff infection4,14

Specific antibiotics are the standard of care for treatment of active C. diff infection

The typical antibiotics used to treat primary C. diff infection are10:

Dysbiosis, an imbalance in the microbiome with low microbial diversity, may be exacerbated by repeated use of antibiotics, creating a window of vulnerability9,16,17

Antibiotics-driven dysbiosis creates an environment susceptible to recurrence4,9,17,18

Antibiotics alone don't address the underlying dysbiosis or the entire 2-phase life cycle of C. diff, and the risk of recurrence continues with increased frequency and patient impact9,14,18

Addressing dysbiosis when treating recurrent C. diff infections can require a multimodal treatment strategy9,14,16,18-20

rCDI presents a unique clinical challenge because of the paradox of antibiotic treatment on the primary C. diff infection, which may lead to continued disruption of the gut microbiome18

The latest treatment goals focus on addressing the underlying dysbiosis (ideally at first recurrence), which can contribute to the vicious cycle of C. diff infections18

Advances in microbiome science are leading to a new treatment paradigm of cointervention therapies18

The 2022 SHEA and IDSA guidelines included antimicrobial stewardship as an essential practice in the fight against C. diff infection.21

The newest treatment modalities could influence future guideline updates, but some challenges remain

Experimental (non-FDA approved) fecal microbiota transplants (FMTs)

Probiotics

Gut microbiome therapies

The American Gastroenterological Association 2024 guidelines recommend the use of these therapies to prevent recurrent C. diff infection, including fecal microbiota live-jslm and fecal microbiota spores live-brpk.30

These new therapeutic options greatly expand the tools healthcare practitioners have in the important fight to reduce recurrent C. diff infection morbidity and mortality at the first sign of recurrence.18

Stay up to date on the latest therapeutic advancements for your patients with recurrent C. diff infections.

Primary and recurrent *C. diff** infection may seem similar, but one presents a different level of risk for your patients.^1-4

Primary and recurrent *C. diff** infection may seem similar, but one presents a different level of risk for your patients.^1-4

The CDC classified C. diff infection as a top 3
public health priority that requires urgent and
aggressive action due to⁵:

**A C. diff infection can occur in 2 different ways**

Primary C. diff infection (pCDI) can lead to several complications, including life-threatening symptoms⁴:

The risk of a second recurrence of C. diff infection
increases significantly after the first^4,7,11

**The clinical, economic, and emotional consequences of recurrent C. diff infections are significant^2,4,8,12,13**

Antibiotics are the standard of care for
primary C. diff infection, but they could
contribute to a recurrent C. diff infection^4,14

**Specific antibiotics are the standard of care for treatment of active C. diff infection**

The typical antibiotics used to treat
primary C. diff infection are¹⁰:

Dysbiosis, an imbalance in the microbiome with low microbial diversity, may be exacerbated by repeated use of antibiotics, creating a window of vulnerability^9,16,17

Antibiotics-driven dysbiosis creates an
environment susceptible to recurrence^4,9,17,18

Antibiotics alone don't address the underlying dysbiosis or the entire
2-phase life cycle of C. diff, and the risk of recurrence continues with increased frequency and patient impact^9,14,18

**Addressing dysbiosis when treating recurrent C. diff infections can require a multimodal treatment strategy^{9,14,16,18-20}**

rCDI presents a unique clinical challenge because of the
paradox of antibiotic treatment on the primary C. diff
infection, which may lead to continued disruption of the gut
microbiome¹⁸

The latest treatment goals focus on addressing the
underlying dysbiosis (ideally at first recurrence), which
can contribute to the vicious cycle of C. diff infections¹⁸

Advances in microbiome science are leading to a new treatment paradigm of cointervention therapies¹⁸

The 2022 SHEA and IDSA guidelines included
antimicrobial stewardship as an essential practice
in the fight against C. diff infection.²¹

The newest treatment modalities could influence
future guideline updates, but some challenges remain

Experimental (non-FDA approved)
fecal microbiota transplants (FMTs)

The American Gastroenterological Association 2024 guidelines recommend
the use of these therapies to prevent recurrent C. diff infection, including
fecal microbiota live-jslm and fecal microbiota spores live-brpk.³⁰

These new therapeutic options greatly expand the tools healthcare practitioners have in the important fight to reduce recurrent C. diff infection morbidity and mortality at the first sign of recurrence.¹⁸

Stay up to date on the latest
therapeutic advancements for your
patients with recurrent C. diff
infections.