Non-conventional antimicrobial and alternative therapies for the treatment of Clostridium difficile infection

Clostridium difficile is an anaerobic, Gram-positive, spore-forming bacillus that causes disease ranging from self-limiting diarrhoea to severe pseudomembranous colitis. C. difficile infection (CDI) commonly affects hospitalised patients and is increasingly identified in patients in the community with no hospital contact. For the last 15 years the incidence of CDI worldwide has been rising, especially in the northern hemisphere. The yearly average number of hospitalizations as a result of this disease is estimated to be over a quarter of a million per year in the United States alone. The main risk factor for CDI is exposure to antimicrobials that affect the gut microflora and, paradoxically, the most common treatments for CDI are the antimicrobials, metronidazole and vancomycin. However, the increasing frequency of highly virulent C. difficile strains, antimicrobial treatment failures, hospital outbreaks, patients with severe complications and cases with multiple recurrences have driven the search for new therapies. Several novel or popular complementary and alternative therapies are self-prescribed for treatment of other diarrheal diseases, and these may also be appropriate for treating CDI. In general, complementary and alternative medicine (CAM) is mainly used by patients when conventional therapeutic agents show limited success against C. difficile and other antimicrobial-resistant bacteria. Among these alternative approaches, a number of treatments, such as herbal remedies, are embraced less by pharmaceutical and medical professions. This review summarises current knowledge of non-conventional antimicrobial and alternative therapies for treatment of CDI. As the demand for non-conventional antimicrobial therapies increases, further studies are required in the field of CAM, especially natural products, for the treatment of CDI.