If you have been involved in the care of patients with refractory Clostridium difficile infection, you are likely aware that fecal microbiota transplantation (FMT) is remarkably effective. Hospitals have struggled with preparation of the transplant material, often using donor stool that is prepared locally in blenders, then introduced into the colon via colonoscopy or to the small bowel via endoscopy. Now, a new study shows the promise of frozen FMT capsules that can be taken orally. In the study from Harvard, 20 patients with relapsing or refractory C. difficile infection received 15 FMT capsules on 2 consecutive days and were followed for 6 months. The capsules were resistant to stomach acid and were stored at -112°F until administration. Resolution of diarrhea was achieved in 14 patients (70%; 95% confidence interval [CI], 47-85%). The six non-responders were retreated and four had resolution of diarrhea, resulting in an overall 90% cure rate (95% CI, 68-98%). The number of daily bowel movements decreased from a median of five to two at day 3 and one at 8 weeks (P < 0.001). There were no serious adverse effects. This preliminary study provides data on rates of resolution and adverse effects in patients with recurrent C. difficileinfections but the authors caution that larger studies are needed (JAMA, published online Oct. 11, 2014. doi:10.1001/jama.2014.13875). It is hoped that there will soon be a commercial FMT product as pharmacy and therapeutics committees struggle to deal with the administration of stool slurries in the inpatient setting.
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