New antibiotics for selective treatment of gastrointestinal infection caused by Clostridium difficile.

IMPORTANCE OF THE FIELD: Clostridium difficile infection (CDI) is associated with consumption of antibiotics which disrupt the normal microbial flora of the gut, allowing C. difficile to establish itself and produce disease. Currently, only vancomycin or metronidazole are recommended for treatment and many patients suffer from relapse on infection. Hence, there is a need for new treatment options. AREAS COVERED IN THIS REVIEW: This review evaluates five agents in development where the focus is on treatment of CDI. WHAT THE READER WILL GAIN: This review gives up-to-date information on fidaxomicin, REP3123, oritavancin, NVB302 and nitazoxanide and their likelihood of being licensed for the treatment of CDI. TAKE HOME MESSAGE: One agent, fidaxomicin, has undergone Phase III clinical trials which show it to be a promising new agent for the treatment of CDI with a low rate of relapse. Nitazoxanide is licensed for the treatment of parasitic intestinal infections but is not licensed for CDI. However, in small scale clinical trials it has been shown to have activity comparable to that of vancomycin and metronidazole. The other agents are all at early stages of development and clinical trials to evaluate their therapeutic potential for CDI have not yet been undertaken.