Editorials

Faecal transplants

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5149 (Published 20 October 2015) Cite this as: BMJ 2015;351:h5149
  1. Tim Spector, professor1,
  2. Rob Knight, professor2
  1. 1Department of Twin Research and Genetic Epidemiology, King’s College London, London SE1 7EH, UK
  2. 2Departments of Pediatrics and Computer Science and Engineering, University of California San Diego, USA
  1. Correspondence to: T Spector tim.spector{at}kcl.ac.uk

Still need good long term trials and monitoring

Recurrent Clostridium difficile infection is a severe and often fatal condition, affecting up to 3000 people in the United Kingdom and 100 000 in the United States, where it kills an estimated 14 000 a year.1 About a quarter of patients experience a recurrence after an initial mild infection because treatment with antibiotics destroys the diversity of the normal gut microbes and allows C difficile to flourish.

The standard of care is antibiotics such as vancomycin and metronidazole, with or without bowel lavage or probiotics. However, a meta-analysis that included two randomised controlled trials and multiple case series covering 516 patients found an 85% success rate with a new non-drug treatment compared with only 20% success for vancomycin.2 That treatment is called faecal microbial transplantation, whereby the liquidised stool (or its cryopreserved microbial content) of a healthy donor is introduced to the colon of the patient through a nasogastric tube or the rectum. A third recent randomised trial was stopped early because of the overwhelming superiority of faecal transplantation, with 90% success rate compared with 26% for vancomycin.3 So far, such transplants seem relatively safe …

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