Fecal Transplant Therapies Recommended for Recurrent C. difficile in Some Patients

A Clostridioides difficile infection (C. difficile) is recognized by the Centers for Disease Control and Prevention (CDC) as an ongoing public health threat with 462,000 new cases diagnosed every year. Infections are most common in those over 65 years of age and those who spend prolonged periods in assisted living, according to the CDC. Symptoms include loose and watery stools, fever and stomach tenderness.

New research from the American Gastroenterological Association (AGA), published in Gastroenterology, greenlights fecal microbiota-based therapies for immunocompetent and mildly and moderately immunocompromised adults with recurrent C. difficile infections. This recommendation does not extend to C. difficile patients who are severely immunocompromised (unless it is as a last resort) or to patients with other inflammatory bowel diseases such as irritable bowel syndrome, ulcerative colitis, pouchitis and Crohn’s disease except in the case of clinical studies.

Guidelines were decided upon by a seven-member panel selected based on clinical expertise which gathered evidence from electronic databases such as the Cochrane Central Register of Controlled Trials.

In C. difficile patients, fecal microbiota-based therapies may be considered by a patient when C. difficile infections no longer respond to antibiotics within 2 to 5 days of treatment or after the third infection.

Alternatives to fecal transplant treatment include a vancomycin taper, tapered-pulsed fidaxomicin or bezlotoxumab.

“Fecal microbiota-based therapies are effective therapy to prevent recurrent C. difficile in select patients,” the authors write. “Fecal microbiota transplant cannot yet be recommended in other gastrointestinal conditions.”