Fecal transplant (FMT) is increasingly used to treat recurrent clostridium difficile infections (rCDI) with reported cure rates of 70-90%. FMT’s efficacy has been studied in prospective and observation studies, however, it is unclear how it performs against fidoxamicin, a newer antibiotic used in the initial presentation and recurrence of CDI.
FMT is probably more efficacious than fidoxamicin and vancomycin for rCDI. My main concern with this study is that it was unblinded as to who received the FMT and could potentially influence the difference in microbiologic vs symptomatic cures with FMT. Interestingly, more patients treated with antibiotics had microbiologic cures than symptomatic cures, (vancomycin 31% microbiologic cure while only 19% clinical cure).
Oral Vancomycin Followed by Fecal Transplantation Versus Tapering Oral Vancomycin Treatment for Recurrent Clostridium difficile Infection: An Open-Label, Randomized Controlled Trial – Susy S. Hota Valerie Sales George Tomlinson Mary Jane Salpeter Allison McGeer Bryan Coburn David S. Guttman Donald E. Low Susan M. Poutanen Clin Infect Dis 2017 Feb 1; 64:272
Small trial of 30 patients assess 14 days of PO vanc followed by a FMT by enema versus 6-week taper of PO vanc. Primary endpoint was c diff recurrence within 120 days. 56.2% in the fecal transplant and 41.7% in the vanc taper arms had recurrence. 5 patients in the fecal transplant arm had recurrence within 7 days.
No significant difference and the trial was stopped early. Similar rates of adverse events.