Many patients with C. difficile infection are prone to recurrence that doubles with each bounceback, Dr. Sadowsky said. Traditional treatments include specific antibiotics or tapered antibiotic therapy, but this is ineffective in many cases. Bacteriotherapy, or fecal microbiota transplantation (FMT) using a full-spectrum of fecal bacteria, is a new, more effective approach, he said.
Fecal bacteria donors go through rigorous, extensive screening. They must be adults who have had no recent antibiotics, no gastrointestinal ailments and no acute viral infections, Dr. Sadowsky said. Transplants are in frozen, standardized microbiota preparations and have no odor.
In an early trial, 11 of 12 patients with recurrent, antibiotic-resistant C. difficile infections improved within days after FMT, said Dr. Sadowsky. Now they have treated many hundreds. Only a few patients needed an additional treatment. Using endoscopy, the proximal colons of recipients appeared healthy and their microbial composition started to look like the donor’s, he said. Primary bile acid composition in the gut was lower after transplant, creating a less permissive environment for germination of C. difficile spores.
“You don’t even need high-tech imagery, because the patients themselves report relief within two days of receiving the material,” he said. Oral capsules may one day replace more expensive, invasive endoscopy delivery of the transplant, he added.
