Friday, February 8, 2013

Stool Transplantation for Recurrent C.difficile Infection- The Evidence Amounts

Nasogastric tube- for infusion of donor feces solution
The evidence supporting stool (fecal microbiota) transplantation for the management of recurrent C.difficile diarrhea continues to flourish. I have previously blogged about this before, in reference to the stool transplantation donor.

Here is a randomized control trial of fecal microbiota transplantation published in the New England Journal of Medicine.

The randomized assignments were one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.

The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile–associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0.001 for both comparisons with the infusion group).

Of note, there were  no significant adverse events reported. 

For recurrent C.difficile infection, stool transplantation may be the new standard of care.

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