Fecal capsules can beat difficult-to-treat C diff infection

Capsules containing a frozen suspension of fecal material may prove to be an effective treatment for Clostridium difficile infection and other bowel conditions, scientists say.
The capsule form of fecal microbiota transplantation (FMT) contained a frozen suspension of fecal material harvested from healthy unrelated donors.
It was well tolerated and effectively resolved diarrhoea in 90 per cent of patients with difficult-to-treat C difficile infection.
"FMT is an excellent treatment for C difficile infection, but traditional methods are time-consuming and technically challenging," said Antonio Gasbarrini from the A Gemelli University Hospital in Italy.
"Advances in the preparation and delivery of FMT will lead to its wider acceptance as a safe and effective treatment for C difficile infection that could supersede antibiotics," he said.

C difficile is a type of bacterial infection that causes severe diarrhoea, intestinal inflammation and cell death.

Standard therapy for C difficile infection includes the use of antibiotics, however, around one-third of individuals will have a recurrent infection and many of these will have multiple recurrences.
The consequences of recurrences of C difficile infection can be severe, resulting in life-threatening illness and frequent hospitalisations.
FMT from a healthy donor to an individual with C difficile infection can restore the healthy gut microbiota and resolve symptoms.
FMT has traditionally been performed using a liquid suspension of feces from a related donor, which is transplanted into the body using a nasogastric tube, endoscopy, enema or colonoscopy.

"Traditional routes of administration all have their drawbacks, so we are excited by the prospect of a capsule formulation," Gasbarrini said.
In the study of the FMT capsule, researchers in the US recruited 20 patients with C difficile infection who had either failed to respond to antibiotic medications or had been hospitalised at least twice as a result of severe symptoms.
The capsules were prepared using frozen liquid stool samples from carefully screened unrelated donors and administered to the patients on two consecutive days.
After the first 2 days of treatment, 14 of the 20 patients (70 per cent) experienced a resolution of their symptoms and remained symptom free for 8 weeks.

After a second course of treatment, four of the remaining patients became symptom free, resulting in an overall 90 per cent rate of symptom resolution.
"Although larger studies are needed to confirm these findings, this study could certainly lead to more widespread use of FMT in the treatment of recurrent C difficile infection," said Gasbarrini.
The study will be presented at the 23rd United European Gastroenterology Week in Spain later this month.