Non-Fecal Microbiota Transplantation Strategies for Treatment of Recurrent Clostridioides difficile Infection.

Athena Adamopoulos, Neil Stollman

Journal: Gastroenterology clinics of North America 2026;55(3):493-501

PMID: 42538092

Abstract

Clostridioides difficile infection (CDI) is a leading healthcare-associated illness with significant recurrence rates and clinical burden. Recurrent CDI (rCDI) arises from microbiota disruption, often exacerbated by antibiotic therapy. Current treatment strategies include fidaxomicin and vancomycin taper regimens, with adjunctive options such as rifaximin in select cases. Preventive approaches focus on environmental decontamination and microbiome preservation. Emerging therapies, including live biotherapeutics, non-toxigenic strains, and microbiome-protective agents, show promise in reducing recurrence. Dietary interventions that enhance microbial diversity may also support recovery. Together, these strategies highlight a shift toward microbiome-centered management of rCDI.

Address: Division of Gastroenterology, Alta Bates Summit Medical Center, Oakland, CA, USA.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: [email protected].

DOI: 10.1016/j.gtc.2026.05.009

MeSH Terms: Humans, Clostridium Infections, Anti-Bacterial Agents, Recurrence, Clostridioides difficile, Fidaxomicin, Vancomycin, Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Secondary Prevention, Microbiota