Recurrent Clostridium difficile infection is
difficult to treat, and failure rates for antibiotic therapy are high. Fecal
microbiota transplantation has been shown to be a superior therapeutic modality
for the treatment of recurrent C.
difficile infection (RCDI) and disease is fecal transplantation. A recent review of 317 patients from 27 case-report series concluded that fecal transplantation
was highly effective and resulted in disease resolution in 92% of patients
involved in the study.
Van Nood and
colleagues provided the first controlled study of treating RCDI with fecal
transplantation. In an open-label, non-blinded manner, 43 adult patients were
randomly assigned to oral vancomycin, oral vancomycin plus bowel lavage or
vancomycin plus bowel lavage followed by fecal transplantation by nasoduodenal
tube. Of the patients in
the randomized group to receive fecal transplantation from a donor, clinical
disease resolved in 81% (13/16) after the first infusion. An additional
infusion from a different donor resulted in resolution in two additional
patients. Of the control groups, clinical resolution occurred in 31% (4/13) of
patients who received vancomycin alone, and in 23% (3/13) of those who received
vancomycin plus bowel lavage.
Fecal
transplantation appears to be a promising therapy for RCDI, but important
unkowns exist. These include the most effective dose, method of preparation, route
of administration, and the safety of using donor samples. With the publication
of one controlled trial, more data are needed to address these concerns.
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