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Clin Infect Dis. 2018 Jul 18;:

Authors: Johnson S, Gerding DN

C. difficile infection (CDI) is mediated by actions of toxin A and toxin B. Fully human monoclonal antibodies directed against the binding domains of these toxins were developed. Despite pre-clinical studies suggesting efficacy for the anti-toxin A monoclonal, actoxumab, the anti-toxin B monoclonoal, bezolotoxumab, alone was shown to be effective in clinical trials. Intravenous infusion of bezlotoxumab at a 10 mg/kg dosage as adjunctive treatment reduced the risk of recurrent CDI over placebo for adult patients at increased risk for CDI recurrence in two large randomized, double-blind trials. Significant benefit was noted for patients with one or more of the following predefined risks; age >65 years, history of CDI, immunocompromise, severe CDI. Overall, bezlotoxumab appeared to be safe, however, an unexplained increased risk of heart failure was noted for patients with underlying congestive heart failure. Further refinement of who would benefit most and when best to administer bezlotoxumab is warranted.

PMID: 30020417 [PubMed – as supplied by publisher]

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