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Most patients receptive to fecal microbiota transplant for C. difficile
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Patients were open to fecal microbiota transplantation for recurrent Clostridium difficile infection, despite its unappealing nature, according to data published in Clinical Infectious Diseases.
“The assumption that patients would find the treatment too unappealing has probably been a major barrier to offering fecal microbiota transplantation as a treatment option,” Kathryn Kirkland, MD, associate professor of medicine at the Geisel School of Medicine at Dartmouth, told Infectious Disease News. “Knowing that patients are open to this option and that they are even more likely to consider it if their doctor recommends it, may prompt physicians to include discussion of fecal microbiota transplantation to treat recurrent C. difficile infection.”
Kathryn Kirkland
Kirkland and colleagues administered surveys to 400 patients and received 192 completed surveys. They found that when they were aware of the efficacy data only, 162 respondents chose fecal microbiota transplantation and 29 chose only antibiotics. When the respondents were aware of the fecal component of the treatment, only 16 patients switched their response to antibiotics alone. There was no significant change to the number choosing fecal microbiota transplantation.
All of the respondents said all aspects of the procedure were at least “somewhat unappealing.” The most unappealing aspects were “the need to handle stool” and “receiving [transplantation] by nasogastric tube.” If it was offered as a pill, 90% of respondents said they would choose it and 94% of respondents said they would choose it if their doctors suggested it.
“Although they find the ideal of fecal microbiota transplantation unappealing, or even ‘gross’ in some cases, patients appear very willing to try this treatment option for recurrent C. difficile,” Kirkland said.
Kirkland and colleagues are currently working on a manuscript to describe the results of a similar survey about the attitudes and practices related to fecal microbiota transplantation among physicians who treat patients with C. difficile.
In an accompanying editorial, Lawrence J. Brandt, MD, professor of medicine at Albert Einstein College of Medicine and Montefiore Medical Center, discussed his experience as a physician offering fecal microbiota transplantation. He said most of his patients were not “‘turned off’ by the fecal nature of the fecal reconstitute; rather, they were “turned on by the possibility — indeed the likelihood — of cure.”
He said the physician community is awaiting the results of two randomized studies of the treatment: the FECAL study, which is completed, and a new study that was recently approved by the NIH.
For more information:
Brandt L. Clin Infect Dis. 2012;55:1659-1660.
Zipursky J. Clin Infect Dis. 2012;55:1652-1658.
Kathryn Kirkland, MD, can be reached at Section of Infectious Disease and International Health-5C, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756; email: Kathryn.kirkland@dartmouth.edu.
Disclosure: Kirkland and Brandt report no relevant financial disclosures.