Is FMT a viable option to treat primary C. difficile infections?

Faecal microbiota transplantation was safe and non-inferior to the antibiotic vancomycin in patients with a primary Clostridioides (C) difficile infection, a randomised non-inferiority study showed.

“C. difficile infections usually occur after antibiotic treatment, due to a disruption of the gut microbiota,” explained Dr Frederik Juul (University of Oslo, Norway). The standard treatment is antibiotics; however, the cure rate is suboptimal (71–79%) and recurrences occur frequently [1]. To investigate the value of FMT, Dr Juul and his research team conducted a non-inferiority trial to compare FMT with the antibiotic vancomycin among patients with a primary C. difficile infection. The 100 participants were randomised 1:1 to FMT or vancomycin (125 mg, 4 times a day for 10 days). The primary endpoint was a combination of clinical cure by day 14, no recurrence by day 60, and no additional treatment needed.

A sustained clinical cure was achieved by 67% of the participants in the FMT arm and 61% of the participants in the antibiotics arm. Adverse events (AEs) were noted in 45% and 35% of the participants in the FMT arm and vancomycin arm, respectively. “The population had a median age of approximately 70 years,” said Dr Juul. “This advanced age is associated with a higher rate of comorbidities, explaining the relatively high AE rates in both arms.” Severe AEs were reported in 26% and 16% of the participants in the experimental and control arm, respectively.

“FMT is safe and non-inferior to vancomycin in patients with primary C. difficile infection,” concluded Dr Juul.

1. 
   
   1. Nelson RL, et al. Cochrane Database Syst Rev. 2017;3(3):CD004610
   2. Juul FE, et al. Fecal microbiota transplant versus vancomycin for primary clostridiodes difficile infection: a randomized non-inferiority trial. Abstract LB02, UEG Week 2024, 12–15 October, Vienna, Austria.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 15 October 202415 October 2024