Monoclonal antibodies against C. difficile toxins reduce recurrence of the infection

New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

A randomized, double-blind, placebo-controlled study included 2 neutralizing, 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 per kilogram of body weight, in patients with symptomatic C. difficile infection who were receiving either metronidazole or vancomycin.

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%).

However, the mean duration of the initial hospitalization for inpatients did not differ significantly between the antibody and placebo groups (9.5 and 9.4 days, respectively).

The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection.

My opinion: It is always encouraging to add new tools to the treatment armamentarium aimed at defeating dangerous infections such as C. diff. colitis. However, monoclonal antibodies are generally very expensive and require intravenous administration.

References:

Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. Israel Lowy. NEJM Volume 362:197-205 January 21, 2010 Number 3.

No antibitoc is superior for initial cure of C. difficile infection. Recurrence is less frequent with fidaxomicin http://goo.gl/dBRDj

Image source: Micrograph of a colonic pseudomembrane in Clostridium difficile colitis, a type of pseudomembranous colitis. H&E stain. Wikipedia, Nephron, Creative Commons Attribution-Share Alike 3.0 Unported license.

Sitting on a patient’s bed, by visitors or doctors, is prohibited by infection control

Iona Heath, general practitioner from London comments on this issue in BMJ:

"I learnt recently from senior nursing colleagues that sitting on a patient’s bed, by either visitors or clinicians, is now also prohibited, apparently in the interests of infection control. A quick internet search of "sitting on the bed" and "infection control" produces a huge list of leaflets from a variety of hospitals, each reinforcing the prohibition.

Doctors should never be discouraged from sitting, because patients consistently estimate that they have been given more time when the doctor sits down rather than stands. Standing makes the conversation seem hurried even when it is not; and, in the hospital setting, sitting on the chair does not seem to work nearly as well, because the levels are somehow all wrong."

Sitting on a chair next to the patient's bed is the best approach.

References:
Do not sit on the bed -- Heath 340: c1478 -- BMJ.

Image source: OpenClipArt.org, public domain.