Fecal microbiota transplantation (FMT) by oral capsules may be an effective approach to treating recurrent Clostridium difficile infection (RCDI), a new study found. Among adults with RCDI, the study found that FMT via oral capsules was not inferior to delivery by colonoscopy for preventing recurrent infection over 12 weeks. Participants were randomly assigned 1:1 to FMT by capsule or by colonoscopy. Among the details:
- Among 116 patients (mean age 58 years, 68% women), 105 (91%) completed the trial, with 57 randomized to the capsule group and 59 to the colonoscopy group.
- Prevention of RCDI after a single treatment was achieved in 96.2% in both groups, meeting the criterion for noninferiority.
- There was no significant between-group difference in improvement in quality of life.
- A significantly greater proportion of participants receiving capsules rated their experience as “not at all unpleasant” (66% vs 44%).
Kao D, Roach B, Silva M, et al. Effect of oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection. A randomized clinical trial. JAMA.2017;318(20):1985–1993. doi:10.1001/jama.2017.17077.
The incidence of both hospital acquired and community acquired C. difficile infection (CDI) has increased over the last 15 years. Recurrent C. difficile infection occurs in 10-30% of patients with C. diff, and the rate of future recurrences goes up to 60% after the third recurrence.1 To reduce the risk of future recurrences, a number of approaches are used and include the use of probiotics, extended courses of antibiotics, emerging treatment with anti-toxin monoclonal antibodies, and fecal transplants. Fecal microbiota transplantation has some of the best efficacy, with reported reductions in CDI of 60-90%.2 The potential for fecal transplantation to take place via capsule opens the road for this to be used more broadly as a prescribed agent for this common problem. —Neil Skolnik, MD
- Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA. 2015;313(4):398-408. doi:10.1001/jama.2014.17103.
- Cammarota G, Ianiro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of Clostridium difficile infection: A systematic review. J Clin Gastroenterol. 2014;48(8):693-702. doi:10.1097/MCG.0000000000000046.
This Week's Must Reads
Obesity Prevalence Among US Adults, JAMA; 2018 Jun 19; Hales, Fryar, et al
Screening for Osteoporosis to Prevent Fractures, JAMA; ePub 2018 Jun 26; US Preventive Services Task Force
Chocolate Intake & Incident CHD in Women , Am J Clin Nutrit; ePub 2018 Jun 21; Greenberg, et al
Site of Death & Patterns of Care in Older Adults, JAMA; ePub 2018 Jun 25; Teno, Gozalo, et al
Medications Don’t Slow T2D Progression in Youth, Diabetes Care; ePub 2018 Jun 25; RISE Consortium
Must Reads in Gastroenterology
Marijuana Use in Adolescents with IBD, J Pediatr; ePub 2018 Apr 16; Hoffenberg, et al
Oral Capsule vs Colonoscopy FMT for CDI, JAMA; 2017 Nov 28; Kao, Roach, et al
Tofacitinib as Induction & Maintenance Therapy, N Engl J Med; 2017 May 4; Sandborn, et al
USPSTF Recommendation for Screening for Celiac Disease, JAMA; 2017 Mar 28; Bibbins-Domingo, et al
Childhood Adiposity and NAFLD in Adulthood, Pediatrics; ePub 2017 Mar 31; Yan, Hou, et al