7/23/2019 Fecal Infusion for C Difficle

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10/14/2015

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Donor Fecal Infusion for Recurrent Clostridium

difficile Infection

Joseph T. DiPiro, Executive Dean and Professor, South Carolina College of Pharmacy, University of SouthCarolina, Columbia and Medical University of South Carolina, Charleston

Topic: A recent study supports the use of infusion of donor feces for recurrent C. difficile infection.1

Background: C. difficile infection has been a persistent problem, commonly after antimicrobial usage. It is the

most common cause of infectious diarrhea in hospitalized patients.2 The incidence and severity of the disease

have increased dramatically since 2000.2 While most cases are resolved with discontinuation of theantimicrobial and treatment with oral vancomycin or metronidazole, relapse after antimicrobial treatment

occurs in approximately 20% of infected patients. The optimal management of patients with multiple relapseshas not been clear. Many different antimicrobials alone or in combination have been tried with inconsistentsuccess.

New Information: A definitive study has been published demonstrating that duodenal infusion of donor feceswas more effective than vancomycin for treatment of recurrent C. difficile infection. Patients with recurrent C.difficile infection were randomized to receive vancomycin 500 mg orally four times per day for 14 days, avancomycin regimen with bowel lavage, or vancomycin 500 mg orally four times per day for 4 days followed

by bowel lavage then an infusion of a solution of donor feces through a nasoduodenal tube. Thirteen of 16 patients (81%) who received the fecal infusion had resolution of the C. difficile-associated diarrhea after thefirst infusion. Resolution occurred in 4 of 13 patients (31%) given vancomycin alone and 3 of 13 patients

(23%) given vancomycin with bowel lavage. Adverse events were not significantly different among thegroups. The fecal infusion group experienced mild diarrhea and abdominal cramping on the day of infusion.

Interpretation and Application: Inf usion of donor feces was concluded to be significantly more effective for treatment of recurrent C. difficil e infection than use of vancomycin. This trial provides strong evidence for using fecal infusion for patients with recurrent infection. This method was described many years ago, butadequate controlled trials had not been conducted to conclusively demonstrate effectiveness of fecaltransfusions. Given the history of failures of many other regimens, including antimicrobials, fecal infusionmay prove an important advance in treatment of patients with recurrent C. difficile infection.

1. Nood EV, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridiumdifficile. N Engl J Med. 2013;368:407-415. [PubMed: 23323867]2. Martin S, Jung R. Gastrointestinal infections and enterotoxigenic poisonings. In: DiPiro JT, Talbert RL, YeeGC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach, 8th ed. NewYork: McGraw-Hill, 2011.

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