There is little doubt that antimicrobial use increases the risks for CDAD and certain compounds or classes of compounds are associated with increased risk. However, the exact role (risk) of each compound is still to be elucidated. With all pharmaceutical products, use is based on a risk-benefit ratio; that is, if the patient will benefit to the extent that using the particular antimicrobial is warranted, risks associated with its use are accepted as a part of patient management. There are a number of new antibiotics in various stages of development (e.g., nitazoxanide, ramoplanin), though none to date have FDA approval for the treatment of CDI.
Little is currently known about the relationship between strain virulence, disease severity, and transmission. Also while the role(s) of Toxins A and B in CDI are well established, the role of the Binary Toxin is not well understood and research is necessary to assess its role in CDAD.
Monoclonal antibodies against C. difficile toxins are under development as a form of treatment to induce passive immunity in patients. Anti-C. difficile vaccines are also being researched.
