In a small prospective clinical trial, researchers randomly assigned people with recurrent C Diff infection to receive fecal microbiota transplantation (FMT), applied by colonoscopy or nasojejunal tube after 4–10 days of vancomycin (125 mg 4 times daily, comparing them to those who received antibiotics alone (either 10 days of fidaxomicin 200 mg twice daily;or 10 days of vancomycin 125 mg 4 times daily). Anyone who had recurrence of CDI following this was offered rescue FMTv. The primary outcome was combined clinical resolution and a negative result from a PCR test for Clostridium difficile (CD) toxin 8 weeks following the allocated treatment. Secondary endpoints included clinical resolution at week 8. 64 patients were studied in all.
The combination of clinical resolution and negative results from the test for CD were observed in 17/24 patients with FMTv (71%), 8/24 patients given fidaxomicin (33%), and 3/16 patients given vancomycin (19%), with the transplant delivering significantly better results than either antibiotic regimens (p< 0.05 in both cases). The rate of clinical resolution was far greater with the transplantation option. There appears little doubt that transplantation was clearly superior to antibiotics, but other relevant issues such as cost, logistics and patient preferences remain as potential barriers to this approach.