Oral Antibiotics as Effective as Fecal Transplant for C difficile

An impression smear photomicrograph of <i>C difficile</i> bacteria grown on cycloserine mannitol blood agar. <i>Photo Credit: CDC/ Dr. Gilda Jones.</i>
An impression smear photomicrograph of C difficile bacteria grown on cycloserine mannitol blood agar. Photo Credit: CDC/ Dr. Gilda Jones.

HealthDay News — A single fecal transplant delivered by enema is apparently no more effective than oral antibiotics in treating recurring cases of Clostridium difficile infection, according to research published in Clinical Infectious Diseases.

Susy Hota, MD, medical director of infection prevention and control at the University Health Network in Toronto, Canada and colleagues randomly assigned patients with recurrent C difficile to 2 treatment groups. Patients in the fecal transplant group were given a 14-day course of oral vancomycin followed by a single fecal enema. The standard treatment group received a 14-day course of oral vancomycin, followed by 4 weeks of tapering doses of the antibiotic. Patients were followed for 120 days.

After an interim analysis, the researchers stopped the trial because the results showed no real difference in outcomes. The team found that 56.2% of patients who received fecal transplant and 41.7% of the standard treatment group experienced recurrence of C difficile infection, which corresponded with symptom resolution in 43.8% and 58.3%, respectively.

"In patients experiencing an acute episode of recurrent C difficile infection, a single fecal transplantation by enema was not significantly different from oral vancomycin taper in reducing recurrent C difficile infection," the authors write. "Further research is needed to explore optimal donor selection, fecal transplantation preparation, route, timing, and number of administrations."

Several authors disclosed financial ties to the pharmaceutical and diagnostics industries.

Reference

Hota SS, Sales V, Tomlinson G, et al. Oral vancomycin followed by fecal transplantation versus tapering oral vancomycin treatment for recurrent Clostridium difficile infection: an open-label, randomized controlled trial. Clin Infect Dis. 2017;64:265-271. doi: 10.1093/cid/ciw731

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