Growing need for faecal transplant for C. difficile

The role of faecal transplants may be set to increase, as C. diff gets trickier to treat

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Faecal transplants may become more popular as Clostridium difficile gets increasingly prevalent and difficult to treat, a Melbourne expert says.

Speaking at the Royal Australasian College of Physicians congress in Melbourne last week, Associate Professor Patrick Charles, from the department of infectious diseases at Austin Health, outlined developments in C. difficile treatments.

“Not only is it getting more common and sometimes more virulent, but it is also getting harder to treat,” Professor Charles said.

“Traditionally we would have gone for oral metronidazole, and generally we have had very good success rates, but more recently we’ve seen more failures with that treatment,” he said.

“If you fail once you have got a pretty high chance of failing with subsequent treatments, and once you get to two or more failures it becomes almost inevitable that it keeps on failing.”

As a result, clinicians have been exploring new treatments for these difficult cases.

One possible treatment is a new drug called fidaxomicin, and another is to slightly taper the dose of vancomycin down over approximately six weeks, he said.

In those who don’t respond to either therapy, Professor Charles said that faecal microbiota transplants were beneficial.

“It’s a hassle to do it, and not much fun for anyone involved, but it’s good to have that option up our sleeves to fix C. diff when nothing else is working.”

At the moment, this method tends to be successful in 80%-100% of C. difficile infections. By comparison, success rates for antibiotics can be as low as 30%.

It’s a hassle to do it, and not much fun for anyone involved, but it’s good to have that option up our sleeves

The transplant replaces the recipient’s gut bacteria with healthy bacteria from a donor, and is usually done using an enema, naso-gastric tube, endoscopy or via a capsule of freeze-dried material ingested by the recipient.

In addition to the therapeutic effects, there were also anecdotal reports of faecal transplants having other surprising effects on recipients, Professor Charles told delegates.

These included rapid weight gain, weight loss, and even depression, with effects appearing to mimic characteristics associated with the donor, he said.

It is hoped that improvements in antibiotic use would mean fewer cases of C. difficile in the future, alleviating the need for more faecal transplants, Professor Charles said.

C. difficile infection is more common in older and sicker patients, but can occur in anyone, he added.

Diagnosis is usually by PCR testing of a faecal sample, specifically asking for C.difficile  which will be available at most laboratories, Professor Charles said.

“If you put on the request slip that the diarrhoea is following antibiotic therapy, then the lab would certainly do a PCR test to make sure they’re checking for C. difficile.”

Faecal transplants are gaining popularity for conditions such as chronic fatigue, irritable bowel syndrome, Parkinson’s and autism.