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Oral capsule– and colonoscopy-delivered fecal transplant equally effective for recurrent C. difficile infection
Clinical Question
Is oral capsule–delivered fecal transplant similarly efficacious to colonoscopy-delivered fecal transplant in preventing recurrent Clostridium difficile infection in adults?
Bottom line
Oral capsule–delivery of fecal transplant material is equally effective to the colonoscopy-delivered method for reducing the risk of recurrent infection in adults with Clostridium difficile infection. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Outpatient (specialty)
Synopsis
Recurrent C. difficile infection (RCDI) occurs in 10% to 30% of patients appropriately treated for an initial infection with antibiotics. These investigators identified adults, aged 18 to 90 years, with at least 3 documented episodes of CDI. Following standard treatment with vancomycin for at least 10 days, study participants (N = 116) randomly received (concealed allocation assignment) fecal microbiota transplantation by capsule (40 capsules under direct observation) or colonoscopy (360 mL of fecal slurry in the cecum). Individuals assessing outcomes were not masked to treatment group assignment because of practical barriers. Complete follow-up occurred for 91% of participants at 12 weeks. Using per-protocol analysis consisting of all patients who adhered to the study protocol, absence of RCDI occurred in 96% of patients in both treatment groups. Similarly, assuming a worse-case scenario, whereby all patients not completing the protocol in the oral capsule–delivered group developed recurrent infection and all those in the colonoscopy-delivered group remained free of recurrence, the group difference was still not significantly different. Secondary analyses including a quality-of-life assessment also found no significant treatment group differences.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
good poem
Good luck getting people to eat poopoo
bad poem
Are these capsules available?
This would save some money I think; no procedural costs!
Is the capsule treatment using the same amount of microbiota or is it concentrated or???
I will be eager to see where this leads us!
Oral fecal transplantation
Could be useful ... once on gets past the whole "ick-factor" thing. Not clear if this study used some kind of refined fecal microbiota or fecal material. Refined fecal microbiota would be a much easier sell, though 40 capsules of anything is a lot to sell. I guess perspective changes if you are miserable with C. difficult diarrhea though.
We need more and readier access to such therapy. Interesting the capsule approach is reasonable, but to take down 40 capsules 'under observation,' may be tricky and yet, easier on "manpower" dispensing than colonoscopy delivery/dispensing.