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Fecal transplant comparable to antibiotics for primary C. difficile
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WASHINGTON, D.C. — Fecal microbiota transplantation as therapy for primary Clostridium difficile infection had similar outcomes compared with antibiotic treatment, according to a study presented at Digestive Disease Week 2018.
“This proof of concept study demonstrated that fecal microbiota transplantation is a promising treatment for primary C. difficile infections and was well-tolerated,” Frederik Emil Juul, Cand.med., from the Olso University Hospital Rikshospitalet in Norway, said in his presentation.
To investigate FMT vs. antibiotic therapy for primary CDI, Juul and colleagues enrolled and randomly assigned nine patients to receive FMT therapy and 10 patients to receive antibiotics. The primary outcome was the rate of CDI resolution without recurrence within 70 days. All patients had received antibiotics before the onset of CDI.
At follow-up, five patients in the FMT group and 4 patients in the antibiotic group achieved resolution of primary CDI without recurrence.
Patients in the antibiotic group switched to Vancocin (vancomycin, Pfizer) or had repeated courses of antibiotics. One patient had continuous diarrhea but did not require further CDI treatment.
“Regarding adverse events, there was one death in the fecal microbiota transplantation group, but this was unrelated to study treatment,” Juul said. “Otherwise, there were no serious adverse events in either group.”
According to Juul, a phase 3 study is currently in progress. – by Talitha Bennett
For more information:
Juul FE, et al. Abstract 28. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosure: Juul reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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Jessica R. Allegretti, MD, MPBH
I’m excited that we’re starting to see fecal microbiota transplantation (FMT) utilized earlier in the C. difficile treatment paradigm. While FMT is typically studied in recurrent disease, this is one of the first trials looking at primary C. difficile. As exciting as that move is, this study was conducted in Norway and the researchers used metronidazole in comparison to FMT. Per the author’s presentation at DDW, Norway’s treatment guidelines still contain metronidazole as first-line treatment for C. difficile, but based on the new IDSA guidelines, metronidazole is no longer first line treatment of C. difficile in the United States. As that is the case, this is not truly a fair comparison. Still, I applaud the authors, as there has been a lot of interest in a primary C. difficile study. A more exciting and fair comparison would be FMT vs. vancomycin, which is the standard of care first-line treatment for primary C. difficile currently.
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