title: Luminal Toxin-Binding Agents for Clostridium difficile Infection.
abstract: OBJECTIVE
  To systematically search the literature for trials evaluating luminal toxin-binding agents (LTBAs) for Clostridium difficile infection (CDI).
  
  
  METHODS
  A systematic search was conducted utilizing PubMed and International Pharmaceutical Abstracts with the following terms: anion-exchange resins, C difficile, cholestyramine, tolevamer, and colestipol. Articles were included if published in the English language and reported clinical outcomes of more than 5 adult humans with CDI treated with LTBAs.
  
  
  RESULTS
  Nearly all clinical trials evaluated LTBA as monotherapy for CDI and LTBAs are inferior to standard therapy. In contemporary practice, LTBAs are employed as adjunctive or sequential therapy for which there is a paucity of data. Some data suggest potential efficacy for recurrent CDI. Current guidelines for CDI assert LTBAs are contraindicated due to drug-drug interactions with vancomycin. However, the impact of this interaction on clinical outcomes has not been evaluated, and it is unknown whether higher doses of vancomycin or separating the administration of LTBAs from vancomycin would mitigate this interaction.
  
  
  CONCLUSIONS
  LTBA monotherapy is inferior to vancomycin and metronidazole for CDI. Some data indicate possible benefit in reducing recurrent CDI, but outcomes with adjunctive and/or sequential LTBAs are unavailable. Further studies are needed to investigate the role of LTBAs for CDI.
authors.affiliation: Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA RyanMcCoy@Creighton.edu.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: McCoy
authors.affiliation: Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Klick
authors.affiliation: Ross University School of Medicine and School of Veterinary Medicine, Roseau, Commonwealth of Dominica, West Indies.
authors.forename: Steven
authors.initials: S
authors.lastname: Hill
authors.affiliation: Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Dull
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000379:methods; D003015:Clostridium Infections / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D008795:Metronidazole / Q000378:metabolism / Q000627:therapeutic use; D014118:Toxins, Biological / Q000378:metabolism / Q000627:therapeutic use*; D014640:Vancomycin / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014118:Toxins, Biological; D008795:Metronidazole; D014640:Vancomycin
keywords: Clostridium difficile; anion-exchange resins; cholestyramine; colestipol; luminal toxin-binding agents; tolevamer