Fecal microbiota spores, live-brpk (VOWST™/VOS) for prevention of recurrent Clostridioides difficile infection.

ABSTRACT

Clostridioides difficile infection (CDI) is a health crisis comprising a majority of healthcare-associated infections and is now being seen in the community. Persistent dysbiosis despite treatment with standard-of-care antibiotics increases risk of recurrent infections. Fecal microbiota transplantation has been an effective way of addressing dysbiosis, but the studies have lacked standardization, which makes outcome and safety data difficult to interpret. Standardized microbiome therapies have demonstrated efficacy and safety for recurrent CDI and have been approved to prevent recurrent infection. In this review, we discuss the data behind and the practice use of fecal microbiota spores, live-brpk (VOWST™ / VOS), a US FDA approved live biotherapeutic for the prevention of recurrent CDI.

Clostridioides difficile infection (CDI) is a serious infection of the gut. It often happens in hospitals and can come back after treatment. Antibiotics are usually used to treat CDI, but they do not always stop it from returning. Fecal microbiota transplantation (FMT), where healthy bacteria from the stool of a healthy donor are transferred to a patient, can work better than antibiotics alone. FMT is not yet approved for use because of the differences in donor screening, fecal material preparation and storage. Because of this, new treatments called standardized microbiome therapies are being developed. One such treatment, VOS, comes as an ingestible capsule containing live bacteria to colonize the gut with healthy bacteria that stop Clostridioides difficile from growing. It is a simple and easy treatment, though may have some mild side effects like gas or stomach pain. This treatment offers a new way to prevent CDI, especially for people at high risk. More research is needed to see how safe VOS is for pregnant women and people with weakened immune systems.