Clostridioides difficile
infection (CDI) is the major identifiable cause of antibiotic-associated diarrhea. The emergence of hypervirulent
C. difficile
strains has led to increases in both hospital- and community-acquired CDI. Furthermore, CDI relapse from hypervirulent strains can reach up to 25%. Thus, standard treatments are rendered less effective, making new methods of prevention and treatment more critical. Previously, the bile salt analog CamSA was shown to inhibit spore germination
in vitro
and protect mice and hamsters from
C. difficile
strain 630. Here, we show that CamSA was less active at preventing spore germination of other
C. difficile
ribotypes, including the hypervirulent strain R20291. Strain-specific
in vitro
germination activity of CamSA correlated with its ability to prevent CDI in mice. Additional bile salt analogs were screened for
in vitro
germination inhibition activity against strain R20291, and the most active compounds were tested against other strains. An aniline-substituted bile salt analog, (CaPA), was found to be a better anti-germinant than CamSA against eight different
C. difficile
strains. In addition, CaPA was capable of reducing, delaying, or preventing murine CDI signs in all strains tested. CaPA-treated mice showed no obvious toxicity and showed minor effects on their gut microbiome. CaPA’s efficacy was further confirmed by its ability to prevent CDI in hamsters infected with strain 630. These data suggest that
C. difficile
spores respond to germination inhibitors in a strain-dependent manner. However, careful screening can identify anti-germinants with broad CDI prophylaxis activity.