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Fecal Transplants Less Effective Than Previously Thought

A new study published by Canadian researchers in Clinical Infectious Diseases indicates that a single fecal transplant may not be any more effective than oral antibiotics in treating Clostridium difficile infections (CDIs).
Although the study has received some criticism for its methods of administration (the transplant was conducted using a single enema and a relatively large amount of stool), the results are important because the study is the first “head-to-head” comparison of fecal transplants and antibiotic treatments, which are presently the “standard” of care.
Lead researcher Susy Hota, MD, medical director of infection prevention and control at University Health Network in Toronto, explained, “I was struck by how many patients I encountered with recurrent C. difficile infection, and it was so challenging to get them out of the cycle of recurrence. [Our team] felt strongly that there was a need for a well-designed study to address the safety and efficacy [of fecal microbiota transplant(FMT)]. There were so many unknowns about how to do it and how well it truly worked.”
C. difficile infections are most common in the elderly , occurring with some frequency in hospitals and nursing homes. Patients already on antibiotics often contract the infection, and C. difficile spores are particularly problematic in institutional settings because they can live for a long time outside the human body on things like bed linens and rails. Some strains of the bacteria are difficult to treat because they are resistant to a number of antibiotics. A patient with a C. difficile infection may experience diarrhea, fever, loss of appetite, and belly pain and tenderness.
The study compared a regimen of 14 days of oral vancomycin followed by one fecal transplant by enema with a 6-week taper of oral vancomycin. Participants were all experiencing recurrent CDI, and patients with significantly compromised immune systems, histories of fulminant CDI, and irreversible bleeding disorders were excluded from the study. Patients could participate if they had at least two episodes of lab- or pathology-confirmed CDI and had been treated with at least one course of oral vancomycin. The patients were randomized at a 1:1 ratio but the study was not blind, “as it would be impractical due to fecal transplant odor” and since the research ethics board’s refusal to endorse sham enemas, the scientists noted.

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