Fecal transplants for the treatment of recurrent Clostridium difficile infection

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.