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Randomised controlled trial
Clinicians should assess the benefits and risks of using bezlotoxumab for reducing the risk of recurrent Clostridium difficile infection
  1. Habiba Hassouna1,
  2. Abhishek Deshpande1,2
  1. 1 Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2 Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Abhishek Deshpande, Medicine Institute Center for Value-Based Care Research, G10, Cleveland Clinic, Cleveland, OH 44195, USA; abhishekdp{at}

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Commentry on: Wilcox MH, Gerding DN, Poxton IR, et al. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med 2017;376:305–317.


Clostridium difficile is an anaerobic gram-positive spore-forming bacillus that plays a major role in healthcare antibiotic-associated diarrhoea. A continued rise in antibiotic use, specifically, cephalosporins and fluoroquinolones, has been linked to the development of more resistant strains of this toxin-forming pathogen, triggering more recurrences and severe manifestations of the disease across USA and Europe.1 The high burden of recurrence and increased healthcare costs associated with C. difficile infection (CDI) have encouraged the development of new treatments to prevent recurrence including the use of pulsed/tapered oral vancomycin, fidaxomicin and faecal microbiota transplantation (FMT).2


Monoclonal antibodies for C. difficile therapy (MODIFY) trials I and II are two global phase 3 trials aimed at examining the efficacy and safety of a single dose (10 mg/kg) of human monoclonal antibodies actoxumab and bezlotoxumab against C. …

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  • Competing interests AD has received research funding from Clorox, 3M and Steris.

  • Provenance and peer review Commissioned; internally peer reviewed.