Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Oral Capsule vs Colonoscopy FMT for CDI

JAMA; 2017 Nov 28; Kao, Roach, et al

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

  1. 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.
  2. 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.

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