Fecal microbiota transplantation (FMT) is safe and effective relative to antibiotic therapy for the treatment of recurrent Clostridium difficile infection, according to a controlled long-term follow-up study. The results were published online December 11 in Alimentary Pharmacology & Therapeutics.
Not only did FMT treatment appear durable, it also showed potential benefits over antimicrobial treatment, Jonna Jalanka, PhD, a postdoctoral fellow at the University of Helsinki in Finland, and colleagues report.
Patients with C difficile infection tend to have a greatly impoverished microbiome, which is believed to be not only a result of the microbial infection but also the antimicrobial regimen used to treat the infection. Patients with C difficile infection also tend to have a higher prevalence of functional gastrointestinal disorders such as upper intestinal tract symptoms, which may result from the infection, the antimicrobial treatment, or both.
In their retrospective study, the investigators followed 84 patients (45 FMT and 39 antibiotics) with recurrent C difficile infection for an average of 3.8 years. The number of episodes before the treatment were similar in both the FMT (3.5) and antibiotic (3.9) treatment groups. Fecal donors were selected on the basis of results of the European consensus conference, which specify history of chronic, systemic autoimmune disorders with gastrointestinal (GI) involvement as well as GI cancer or polyposis as important issues in donor selection.
Safety
When the researchers compared the two treatment groups, they found no difference in the incidence of severe diseases: inflammatory bowel disease, cancer, autoimmune disease, allergy, and neurological diseases. Weight gain also was similar among the two groups.
The investigators documented two relatively common conditions — migraines and dementia — which occurred equally in both treatment groups (four in each group for migraines and three in each group for dementia).
Although the researchers did not find a statistical difference in allergies between the two treatment groups, approximately twice as many patients in the antibiotic treatment group developed new allergies during follow-up compared with patients in the FMT group (6 vs 3).
Efficacy
Patients in the FMT group reported their bowel function became more regular and their bowel habits improved significantly faster compared with patients in the antibiotic group. Specifically, 77.8% of patients in the FMT group reported that all symptoms of C difficile infection resolved in 3 or fewer days compared with only 23.1% of antibiotic-treated patients, which was statistically significant.
The FMT group also experienced statistically fewer functional dyspepsia-like symptoms in the upper GI tract than patients in the antibiotic group (31.1% vs 51.3%; P = .045). Patients in the FMT group reported less pain in the upper GI tract than patients treated with antibiotics (11.1% vs 25.6%; P = .06). The investigators also found a significant difference in the feeling of bothersome fullness after a meal between the FMT-treated and antibiotic-treated patients (4.4% vs 18.0%; P = .05).
The majority (45.7%) of patients in the study reported no change in mental well-being, but more patients in the FMT group reported improved mental health after treatment than did patients in the antibiotic group (31.1% vs 8.9%; P = .06).
Looking Forward
The broad-spectrum antibiotics such as macrolides or tetracycline that are frequently used to treat C difficile infection may be associated with the development of irritable bowel syndrome. In fact, an estimated 25% of patients with previous C difficile infection experience irritable bowel syndrome–like symptoms after the infection has been cleared with antibiotics. This new study demonstrated that FMT is a safe and acceptable treatment option for patients with recurrent C difficile infection, and thus should be considered as an alternative to treatment with antimicrobials.
When questioned about their willingness to receive FMT treatment for a potential new C difficile infection, patients in both the FMT and antibiotic treatment groups expressed willingness to try FMT as opposed to other treatment options. In particular, 97.6% of patients in the FMT treatment group reported that they would prefer FMT as their initial treatment instead of antibiotics.
The authors have disclosed no relevant financial relationships.
Aliment Pharmacol Ther. Published online December 11, 2017. Abstract
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