Is fecal microbiota transplantation (FMT) an effective cure for recurring Clostridium difficile (C diff) colitis?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Answer

Long-term data from a fecal transplantation clinical trial (≥3 mo from the time of fecal transplantation) revealed that of the 77 of 98 patients who could be contacted, 91% did not have a relapse. [6] Of the patients who did relapse, all but 1 were treated successfully with vancomycin or additional fecal transplantation. [6]

In the first randomized, controlled trial of fecal transplantation, investigators in the Netherlands found fecal transfer to be 3 times more effective than antibiotics in curing recurrent CDI, leading to the study’s early termination. [7, 8] The study compared 3 treatments: (1) standard vancomycin therapy (500 mg PO QID for 14 days), (2) standard vancomycin therapy plus bowel lavage, and (3) 4 days of vancomycin therapy (500 mg PO QID) followed by bowel lavage and infusion of donor feces through a nasoduodenal tube. [7, 8]

In a retrospective study of 83 immunocompromised patients who underwent fecal transplantation for recurrent (12%), refractory (54%), or severe (34%) CDI, the cure rate after a single transplant was 79% (52 of the 66 patients with at least 12 weeks of follow-up). Seven of the 9 patients who underwent a second transplant were also cured. Mean follow-up was 12 months. Serious adverse events, including 2 deaths, occurred within 12 weeks of the transplant in 10 patients (15%). [67]

Of the patients treated with fecal transplantation, 13 of 16 (81%) had resolution of C difficile –associated diarrhea after the first infusion, and 2 of the 3 remaining patients experienced resolution after receiving a second infusion with feces from a different donor. [7, 8]  By contrast, CDI resolved in only 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage. [7, 8]


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