Fecal transplants beat antibiotics for curing diarrhea caused by C. difficile

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Fecal transplants are tops when it comes to treating stubborn Clostridium difficile infections (C. diff), according to a new study.

The not-so-pleasant-sounding procedure -- that involves taking donor feces and infusing them into the small intestine of those who suffer from the tough-to-treat bacterial infection -- was found to outperform antibiotics in a new clinical trial published Jan. 16 in the New England Journal of Medicine.

Fecal transplants, known by doctors as fecal microbiota transplantation, were first used in 1958 to "re-establish the balance of nature" in a person whose gut bacteria was depleted by antibiotic treatments, according to the Journal. For the procedure, a stool is taken from a healthy person -- often a relative --and infused into the colon of the infected person to restore the balance between "good and bad" bacteria in the colon, thereby eliminating the life-threatening infection.

This is the first study to take a group of people with recurring C. diff infections and compare fecal transplants' effectiveness against other treatments. Previous research has relied on observational reports.

"After the first four or five patients, we started thinking, 'We can't go on doing this kind of obscure treatment without evidence,' " study author Dr. Josbert Keller, a gastroenterologist at the Hagaziekenhuis hospital in The Hague in the Netherlands, told the New York Times about the reasoning behind his study. "Everybody is laughing about it."

C. diff is a toxic-producing bacterium that causes diarrhea in about 14,000 American deaths each year, according to the Centers for Disease Control and Prevention. Symptoms can include diarrhea, fever, loss of appetite, nausea and abdominal pain. The infection can be spread by contact with anything contaminated with feces. iI is an especially big problem at hospitals, because health care workers may inadvertently spread it to patients after coming in contact with contaminated surfaces.

In the new study, a group of 43 patients with recurring C. diff infections were randomly assigned to receive either a "fecal infusion," antibiotics or antibiotics with a colonic. The researchers found that 13 of the 16 people who received the transplant saw their diarrhea subside immediately, compared to only four out of 13 patients in the antibiotic group and three of 14 patients in the antibiotic-plus-colonic group.

The treatment was so effective, that 18 patients who had the infection relapse after taking antibiotics were given the transplant, and 15 of them were cured -- for 11 of them, after just one infusion.

"This could be viewed as another form of recycling: one man's waste is another man's treasure," Dr. James Versalovic, professor of pathology and immunology at Baylor College of Medicine and Texas Children's Hospital, told USA Today. He was not involved in the study.

In an accompanying editorial published in the same journal issue, Dr. Ciaran P. Kelly, a professor of medicine at Harvard University, writes that past research suggests the transplant is 90 percent effective, and questions why it hasn't become a routine treatment over the past fifty years.

"There are three main reasons," he wrote. "It is aesthetically unappealing, it is logistically challenging (in terms of harvesting and processing suitable donor material), and there is a lack of efficacy data from randomized, controlled trials."

However, he adds, the new study provides that "important confirmation" of the procedure's effectiveness.

One woman, 34-year-old Melissa Cabral of Dighton, Mass., told The New York Times that the transplant was the only thing that stopped her repeated bouts of C. difficile infections, which caused her to lose 12 pounds and miss months of work. The transplant cured her symptoms within a day, she said.

"If I didn't do it, I don't know where I'd be now," said Cabral, who first rejected the procedure because the idea disgusted her.

In October, studies presented at the American College of Gastroenterology's annual meeting found C. diff infections could cause children to be hospitalized an average of four days longer, and fecal transplants could speed up recovery.

"Those of us who've been doing this procedure for some time didn't need any more convincing, but the large medical community needs to go through these steps," Dr. Alexander Khoruts, a gastroenterologist at the University of Minnesota in Minneapolis who was not involved in the new study, told Nature. "It's an unusual situation where we have more than 50 years of worldwide experience and more than 500 published cases, and only this far along does a randomized trial appear."

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