Introduction

C. difficile is a spore forming, gram positive anaerobe and one of the most common leading cause of hospital-acquired infections. It is most often linked with antibiotic associated diarrhea, pseudomembranous colitis and toxic megacolon. This review examines current and new therapeutics for CDI with focus on current limitations and possible advances.

Overview of Current Treatment Strategies

1. Antibiotic Therapy
The standard treatment of CDI includes antibiotics such as vancomycin and fidaxomicin. Vancomycin is very effective at killing vegetative cells although the rates of recurrence are between 20-25% (Kelly & LaMont, 2008). Fidaxomicin is less expensive and is given less frequently but is more effective in reducing recurrence (Louie et al., 2011).
Limitations:
• Antibiotics do not eradiate spores hence there is always a recurrence of the infection.
• Eradication of CDI does not occur because the gut microbiota is continue to be disrupted.
2. Combination Therapy
Some new strategies that have been used in the recent past include the concurrent use of antibiotics and monoclonal antibodies such as bezlotoxumab. Bezlotoxumab aims at toxin B and helps in decreasing the rate of recurrence, however the expense is very high therefore its application is restricted (Wilcox et al., 2017).

Fecal Microbiota Transplantation (FMT)
FMT has revolutionalized the management of recurrent CDI with recurrence rates of less than 15% and cure rates of more than 85% (Cammarota et al., 2017). It works in this manner because it helps to diversify the types of bacteria in the gut thus addressing the cause of the disease.

Strengths:
• High efficacy in the treatment of refractory and recurrent disease.
Limitations:
• Transmission of infection with tainted donors, without proper donor selection.
• Inconsistent regulation and accessibility across the globe (Smits et al., 2016).
Despite the difficulties that are present with FMT, it does show the world a new type of treatment that is based on the microbiome.

Future Directions

These new strategies are aimed at minimizing the rate of recurrence and the reconstruction of the normal microbiota:
• Probiotics: Such strains as Lactobacillus are studied as an additional treatment to antibiotics but the results are ambiguous (Ouwehand et al., 2002).
• Vaccines: Preventive vaccines containing C. difficile toxins have the potential but is still in the development (Kuehne et al., 2014).
• CRISPR-Cas Systems: These tools target only C. difficile DNA and do not affect the other healthy gut bacteria that is why it is considered to be a novel microbiota-preserving treatment (Bikard et al., 2014).
The study of these approaches demonstrate continuing focus on the management of CDI whilst seeking to minimise the effects on the gut microbiota.