Systematic Review of Fecal Microbiota Transplantation for C. difficile Infection

Douglas K. Rex, MD reviewing Drekonja D et al. Ann Intern Med 2015 May 5.

Pending larger trials, available data support liberal use of FMT for patients with multiple recurrences.

As Clostridium difficile infection has become more widespread and severe, interest in fecal microbiota transplantation (FMT) as an alternative therapy has increased. FDA policy currently allows for the clinical use of FMT in treating C. difficile infection.

In a systematic review of FMT for treatment of C. difficile infection, researchers identified two small randomized, controlled trials (RCTs); 28 case series; and 5 case reports. In the trial using non-FMT control groups, resolution of symptoms occurred in 81% with FMT compared with 31% with vancomycin and 23% with vancomycin plus bowel lavage (P<0.001 for both). In the second trial, a comparison of nasogastric versus colonoscopic administration of FMT showed no difference in resolution (60% vs. 80%; P=0.63). Among 21 case series of 480 patients with recurrence of C. difficile infection, symptom resolution was 85%. The overall resolution in studies of patients with refractory disease was 55%.

Citation(s):

Drekonja D et al. Fecal microbiota transplantation for Clostridium difficile infection: A systematic review. Ann Intern Med 2015 May 5; 162:630. (http://dx.doi.org/10.7326/M14-2693)