Fecal transplant as good as antibiotics against C. difficile, in pilot study

Last Updated: 2018-06-04

By Gene Emery

(Reuters Health) - Transplanting fecal material into the colon, already shown to be an effective treatment for a recurring Clostridium difficile infection, may be as good as antibiotic therapy as a first-line treatment, a pilot study of 20 adults is suggesting.

Five of nine patients (56%) who received one 60 ml transplant of feces from a healthy donor had a complete response that lasted 70 days versus 5 of 11 (45%) who received 400 mg of the antibiotic metronidazole three times a day for 10 days.

Another 3 metronidazole recipients had a temporary response.

Among 2 of the fecal transplant patients for whom the treatment didn't work, follow-up therapy with the antibiotic cleared the disease for at least 70 days.

A larger trial, which will also explore whether a second fecal transplant reduces the failure rate, is underway.

"This is very exciting. It's a very small trial. It's proof of concept. It's not definitive," coauthor Michael Bretthauer of Oslo University and the Harvard School of Public Health told Reuters Health in a telephone interview. "But I think that the larger trial will show the same, and this will be introduced in clinical practice."

The results were presented June 2 at the Digestive Disease Week meeting in Washington, D.C., and online in the New England Journal of Medicine.

Such transplants are not widely embraced, typically considered a last resort for disease that's resistant to antibiotic therapy. "I think it's used for really bad patients that never get better and as a last resort," said Dr. Bretthauer, who said doctors in Europe seem to have been more receptive to the treatment.

One issue with the transplants is that nobody knows which bacterium or group of bacteria are responsible for the improvements seen in many patients.

"Of the hundreds of thousands of species in people's poo, is there one species that works for this, or is it a combination?" said Dr. Bretthauer. "The guy who finds out what's the one -- or the 10 -- will get a Nobel Prize."

Last September, researchers from France reported that people with a severe infection showed improved survival with a transplant. Patients with less-severe disease showed no survival benefit.

Positive results for fecal-microbiota transplants have been reported for people with moderate-to-severe irritable bowel syndrome, active ulcerative colitis and inflammatory bowel disease in general.

SOURCE: https://bit.ly/2srgINT

N Engl J Med 2018.