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Diarrhea resolution was 90% in patients with recurrent or relapsing C. difficile infection.

Relapse of Clostridium difficile infection after antibiotic treatment with metronidazole or vancomycin occurs in 20% to 30% of patients. Patients with multiple relapses have a risk for additional relapse of up to 60% and become candidates for fecal microbiota transplantation (FMT); this is usually accomplished by colonoscopy in the U.S. but has also been achieved by administration of feces by enema, nasogastric tube, and upper endoscopy, and with frozen encapsulated feces.

In the current uncontrolled study, researchers assessed the feasibility of FMT by oral administration of frozen, capsulized feces in 20 patients with refractory or recurrent C. difficile infection. The four donors were unrelated to patients.

Patients discontinued antibiotics 48 hours prior to FMT and fasted for 4 hours prior to and 1 hour after capsule intake. Patients were given 15 capsules on 2 consecutive days. If diarrhea did not improve after 72 hours, they were retested and offered retreatment.

Fourteen patients had clinical resolution of diarrhea after the first FMT and were symptom-free at 8 weeks. The six nonresponders were retreated at a mean of 7 days after the procedure, and five had resolution of diarrhea after the second treatment. One of the five patients relapsed within 8 weeks, for an overall rate of diarrhea resolution of 90%.

COMMENT

The oral use of frozen encapsulated fecal material for FMT seems to be a major improvement over current methods of treating relapsing C. difficile infection — for a number of obvious reasons. The major risks seem to be vomiting and aspiration, which did not occur in this small, non–placebo-controlled trial. Pending commercialization of frozen encapsulated fecal material, or development of safe, reliable protocols for institutions to create their own frozen encapsulated feces, colonoscopy will likely remain the primary means of FMT administration.

Douglas K. Rex, MD reviewing Youngster I et al. JAMA Nov 5.

CITATION(S):

Youngster I et al. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA Nov 5; 312:1772.