Updates in the Management of Clostridium Difficile for Adults

Kimberly E. Ng, PharmD, BCPS


US Pharmacist. 2019;44(4):HS9-HS12. 

In This Article

Fecal Microbiota Transplant

The current guidelines recommend fecal microbiota transplantation for patients with multiple recurrences of CDI in whom antibiotic treatment has failed. The gastrointestinal tract is estimated to have over 160 bacterial species, with a majority residing within the colon. Since antibiotics suppress the growth of normal gut bacteria, pathogens like C difficile can proliferate. Butyrate is a short-chain fatty acid (SCFA) that is produced by bacteria that tends to be depleted in CDI. SCFA is important for energy production, immune function, and normal gut microbial growth. Recurrent CDI also reduces Bacteroidetes and Firmicutes, which are dominant gut flora. Reimplanting these strains of bacteria via fecal transplantation from healthy individuals can restore normal gut biodiversity. Mean cure rates for recurrent CDI are reported to be 91% to 96% with fecal transplantation. A variety of routes of administration have been reported in literature including nasogastric administration, rectal enema, colonoscopic administration, and oral preparations of frozen fecal microbial transplant capsules.[2,4]