https://immattersacp.org/weekly/archives/2015/05/12/6.htm

Fecal transplants for recurrent C. diff may resolve symptoms with few adverse events

Low-strength evidence shows fecal microbiota transplantation (FMT) effectively treats recurrent Clostridium difficile infections (CDIs), with few short-term adverse events, a review found.


Low-strength evidence shows fecal microbiota transplantation (FMT) effectively treats recurrent Clostridium difficile infections (CDIs), with few short-term adverse events, a review found.

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Researchers conducted a literature search to find 2 randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports (included only for reporting harms) assessing FMT. Results of their analysis, which was funded by the Department of Veterans Affairs, appeared in the May 5 Annals of Internal Medicine.

Across all studies of FMT for recurrent CDI, symptom resolution was seen in 85% of cases. In the 2 RCTs, totaling 36 patients with recurrent CDI, 27 (75%) had resolution of CDI symptoms without recurrence. One RCT comparing FMT with 2 control groups reported resolution of symptoms in 81% of patients who received FMT, 31% of patients who received vancomycin, and 23% of patients who received vancomycin plus bowel lavage (P<0.001 for both control groups vs. FMT). An RCT comparing different FMT routes of administration for CDI recurrence reported no difference between groups (60% had their symptoms resolved in the nasogastric tube group, as did 80% in the colonoscopy group; P=0.63). Among the 480 patients in 21 case-series studies who received FMT for recurrent CDI, 85% had resolution of symptoms without recurrence.

There were 7 studies reporting on patients with refractory CDI treated with FMT, and they used various methods and did not compared FMT with standard therapy. Reported resolution of symptoms ranged widely (0% to 100%; overall resolution rate, 55%).

Case-series studies included 7 patients treated with FMT for initial CDI, with mixed results. Six cases were part of a series of 14 patients with refractory CDI, and 1 case was part of a series of 4 patients. Among the 6 cases, 1 was cured after FMT. The other, single case received FMT as initial treatment of an episode of postantibiotic-associated colitis and had symptom resolution within 48 hours.

“[L]ow-strength evidence supports FMT as having a substantial effect and few short-term adverse events for adults with recurrent CDI,” the authors wrote. “There is insufficient evidence about FMT for patients with refractory CDI or for initial treatment of CDI. Evidence is insufficient about whether treatment effects vary by FMT donor, preparation, or delivery method.”

The author of an accompanying editorial stated that FMT is effective, provides durable cures, and can result in a cost savings of $17,000 per patient in recurrent cases. Remaining issues include the need for regulations to standardize the treatment, which is currently considered a biologic by the FDA, and the potential effects of transplanting a microbiome from one patient to another.

“The excitement about FMT is justified given its high efficacy in treating recurrent CDI, relative availability and simplicity, and favorable cost profile compared with other therapies,” the editorial stated.