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  1. Guruprasad P Aithal, Editor

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Beyond antibiotics for C difficile?

▶ Lowy I, Molrine DC, Leav BA, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010;362:197–205.

Antibiotics remain the standard therapies for Clostridium difficile infection, which has now become a public health problem in Western countries. Given that it is increasing in incidence, severity, and rates of recurrence, new therapies are undoubtedly needed to tackle it. Lowy et al performed a randomised, double-blind, placebo-controlled study of two neutralising, fully human monoclonal antibodies against C difficile toxins A (CDA1) and B (CDB1). The antibodies were administered together as a single infusion, each at a dose of 10 mg/kg body weight, in patients with symptomatic C difficile infection who were receiving either metronidazole or vancomycin. The primary outcome was laboratory-documented recurrence of infection during the 84 days after the administration of monoclonal antibodies or placebo.

Among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C difficile infection was lower among patients treated with monoclonal antibodies (7% vs 25%; 95% CI, 7 to 29; p<0.001) (figure 1). The recurrence rates among patients with the epidemic BI/NAP1/027 strain were (8% vs 32%; p=0.06) and among patients with more than one previous episode …

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