Research News

Donor faeces for recurrent Clostridium difficile diarrhoea?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f376 (Published 23 January 2013) Cite this as: BMJ 2013;346:f376

A small trial from the Netherlands suggests that duodenal infusions of healthy human faeces could be an effective treatment for recurrent Clostridium difficile diarrhoea. Just 43 patients had been recruited when a data monitoring board stopped the trial early because control treatments looked so ineffective. All 43 had experienced multiple recurrences of C difficile infection, despite recommended treatment with vancomycin, and were willing to try a duodenal infusion of the supernatant from a suspension of faeces donated by healthy volunteers.

Sixteen patients had the infusions, which were given through a nasoduodenal tube after four days of oral vancomycin and a bowel lavage. Thirteen were cured after one infusion and another two were cured after a second infusion from a different donor (total cure rate 15/16). Cure rates were significantly lower in two groups of controls who received two weeks of oral vancomycin (4/13) or two weeks of oral vancomycin plus bowel lavage (3/13). The authors defined cure as three stool samples clear of C difficile toxin and no relapse of C difficile diarrhoea within 10 weeks.

Duodenal infusions of donor faeces caused transient diarrhoea (15 patients), abdominal cramps (five), and belching (three), but helped restore a more diverse and healthy gut flora within two weeks.

The trial may be imperfect but it is the first randomised evidence supporting a treatment that was tested anecdotally (successfully) 50 years ago in the form of faecal enemas, says a linked editorial (doi:10.1056/NEJMe1214816). Transplantation of faecal microbiota can at last be developed, refined, and evaluated properly.

Notes

Cite this as: BMJ 2013;346:f376