Donor Fecal Infusion Effective for C. difficile Infection
Fecal infusion more effective for recurrent infection than vancomycin with, without bowel lavage
WEDNESDAY, Jan. 16 (HealthDay News) -- Duodenal infusions of donor feces are significantly more effective than vancomycin for treating recurrent Clostridium difficile infections, according to a study published online Jan. 16 in the New England Journal of Medicine.
Els van Nood, M.D., from the University of Amsterdam, and colleagues randomized patients with recurrent C. difficile infections to receive either vancomycin (500 mg orally four times per day for four days) followed by a bowel lavage and infusion of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage.
The researchers stopped the study after interim analysis when it was determined that, after the first infusion, 13 of 16 patients in the infusion group had resolution of C. diffile-associated diarrhea. After a second infusion from a different donor, two additional patients had resolution. Resolution of infection was noted in four of 13 patients receiving vancomycin alone and in three of 13 patients receiving vancomycin and bowel lavage (P < 0.001 for comparisons with the infusion group). There were no significant between-group differences in adverse effects, although patients in the infusion group experienced mild diarrhea and abdominal cramping on the infusion day. Patients receiving the donor infusions exhibited increased fecal bacterial diversity similar to that seen in the healthy donors.
"In conclusion, in patients with recurrent C. difficile infection, the infusion of donor feces, as compared with vancomycin therapy, resulted in better treatment outcomes," the authors write. "In particular, patients with multiple relapses of C. difficile infection benefited from this unconventional approach."
Several authors disclosed financial ties to the pharmaceutical industry.