What are the benefits of Fecal Microbiota Transplantation (FMT)?

From the Guidelines

Fecal microbiota transplantation (FMT) is a highly effective treatment for recurrent Clostridioides difficile infection (CDI), with a clinical resolution rate of 92% (95% CI 89-94%) as reported in a recent review of 37 studies, including 7 randomized controlled trials and 30 case series 1.

Benefits of FMT

The benefits of FMT include:

• High success rates with long-term durability, making it an attractive option for patients with multiple recurrences of CDI who have failed appropriate antibiotic treatments 1
• Ability to restore the intestinal microbiota, correcting the imbalance that allows C. difficile strains to grow and produce CDI 1
• Potential benefits for inflammatory bowel diseases, irritable bowel syndrome, and metabolic disorders, although more research is needed to confirm these benefits

Administration of FMT

FMT can be administered via:

• Colonoscopy, which has been shown to have a higher cure rate compared to upper gastrointestinal delivery routes 1
• Enema, which is also an effective route of administration, although slightly less effective than colonoscopy 1
• Capsules, which offer a less invasive and simpler alternative, with a clinical resolution rate of 90% in one study 1

Safety and Risks

While FMT is generally safe, patients should be aware of potential risks, including:

• Temporary digestive discomfort
• Theoretical risk of transferring infections, which is minimized through rigorous donor screening 1

Recommendations

FMT should be considered as a treatment option for patients with recurrent CDI who have failed appropriate antibiotic treatments, and should be administered by experienced gastroenterologists following established protocols for donor screening and material preparation 1.

From the Research

Benefits of Fecal Transplant

• Fecal microbiota transplantation (FMT) has been shown to be effective in treating recurrent Clostridium difficile infection (rCDI) 2, 3, 4, 5, 6
• FMT has been found to be superior to fidaxomicin and vancomycin in achieving clinical and microbiological resolution of rCDI 2
• The treatment promotes the recovery of colonization resistance in mice better than vancomycin 3
• FMT can replenish intestinal microbiota by augmenting the relative abundance of the phylum Bacteroidetes and eliminating the abundance of the phylum Proteobacteria 3
• A pseudomembrane-driven FMT protocol consisting of multiple faecal infusions and concomitant vancomycin was significantly more effective than a single faecal transplant followed by vancomycin in curing severe Clostridium difficile infection refractory to antibiotics 4
• FMT has a favorable safety profile and has shown a high success rate for rCDI 5
• The delivery of donor faeces via colonoscopy has the potential to optimise the treatment strategy in patients with pseudomembranous colitis 6

Comparison with Other Treatments

• FMT was found to be more effective than vancomycin in treating recurrent C. difficile infection 6
• FMT was also found to be more effective than fidaxomicin in achieving clinical and microbiological resolution of rCDI 2
• Vancomycin treatment could ameliorate CDI-induced clinical features and intestinal tissue damage, but FMT could replenish intestinal microbiota and restore colonization resistance better than vancomycin 3

Potential Applications

• FMT has the potential to be used as a treatment for severe Clostridium difficile infection refractory to antibiotics 4
• FMT may also be used to prevent rCDI by restoring colonization resistance in patients at risk of developing the infection 3
• Newer methods of microbiota replacement therapies, including enema- and capsule-based therapies, are under investigation 5