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The gut microbiome is important to human health and provides colonization resistance against opportunistic pathogens like Clostridium difficile [1-3]. When the balance of the gut microbiome is perturbed, colonization resistance can be lost allowing overgrowth of pathobionts, potentially leading to infection [1,4]. The mechanism of colonization resistance has been well documented for C. difficile as strains of gut bacteria metabolize primary bile salts to secondary bile salts, which, in turn, inhibit germination of C. difficile spores [5]. When these beneficial bacteria, most of which are obligate anaerobes, are lost, so too is the inhibition of C. difficile germination. Thus, alterations to gut microbiome composition in the presence of C. difficile spores can result in fulminant C. difficile infection (CDI) [6].

Ribaxamase, an orally administered β-lactamase, protects the gut microbiome in patients treated with ceftriaxone