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Fecal transplantation using pills had high success rate against recurrent C. difficile
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SAN FRANCISCO — All patients in a recent study who received fecal microbiota transplantation by taking a pill were protected against recurrent Clostridium difficile infection, researchers reported here at ID Week 2013.
Traditionally, fecal transplantation has been delivered using an enema, colonoscopy or nose tube, and studies suggest these methods are effective in as many as 90% of patients with a CDI. However, swallowing pills may be less intrusive and a more effective method of delivering fecal bacteria from healthy donors to maintain the balance of bacteria in the gastrointestinal system.
"Recurrent C. difficile infection is such a miserable experience and patients are so distraught that many ask for fecal transplantation because they've heard of its success," study researcher Thomas Louie, MD, professor of medicine at the University of Calgary, Alberta, said in a press release. "Many people might find the idea of fecal transplantation off-putting, but those with recurrent infection are thankful to have a treatment that works."
Thomas Louie
For the study, Louie and colleagues processed donated feces until only bacteria remained. The bacteria were encapsulated in three layers of gelatin capsule, which allowed the pills to reach the small intestine before breaking down — an advantage over other delivery methods because it covers more of the gastrointestinal tract, they said.
The researchers reported that none of the patients (n=27) who took the tablet-sized pills in their study had a recurrence of C. difficile. The patients, all of whom had at least four bouts of CDI, received between 24 and 34 capsules containing fecal bacteria, which were often donated by family members.
"The pills are a one-shot deal and seem to work," Louie said. "They are easier for patients and are well tolerated. It's an exciting development in the field and could possibly even be used to maintain the balance of bacteria in the GI system in patients at risk for C. difficile."
In a related study that was also presented here, researchers surveyed 28 patients 3 months after they had undergone fecal transplantation using a nose tube. The patients rated their treatment experience on a scale of 1 to 10. Average scores were 9.6 for overall satisfaction, 9.9 for ease and 9.9 for likelihood of recommending the procedure to a family member or friend.
At a press conference, study researcher Ravi Kamepalli, MD, an infectious disease physician at the Regional Infectious Disease-Infusion Center in Lima, Ohio, said clinicians first need to overcome the "yuck factor" associated with the treatment so patients can benefit from it.
Ravi Kamepalli
In addition to conducting the survey of patient satisfaction, Kamepalli and colleagues treated 40 patients with recurrent C. difficile using fecal transplantation, with a 98% success rate.
"My concern is for the acute patients with C. difficile who suffer a lot, and I think this therapy has a great role for that, too," he told Infectious Disease News. "Before the FDA ruling giving us the 'okay' for recurrent C. difficile only, we treated six patients in an ICU/critical care setting, and five of the six patients who we thought would die, survived. In these patients we continued standard of care and performed fecal bacteriotherapy via a nasogastric tube into the duodenum over 48 hours, as we do for our recurrent C. difficile patients. I hope the FDA clarifies its stance on acute treatment in the critical care setting."
For more information:
Louie T. Abstract #89. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.
Kamepalli R. Abstract #1407. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.
A video demonstrating fecal bacteriotherapy by Kamepalli can be viewed by clicking here, and his website can be accessed here.
Disclosure: The researchers report no relevant financial disclosures.