Faecal transplant more effective than antibiotics for recurrent C. diff, says Nice

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Women stomachache
An overgrowth of the bacteria Clostridioides difficile can cause diarrhoea, abdominal pain and bloating. (Stock, Getty Images)

A faecal transplant is more effective at treating recurrent Clostridioides difficile infections than commonly-used antibiotics, according to the National Institute for Health and Care Excellence (Nice).

The nauseating-sounding procedure involves the waste of a healthy donor being processed and then transplanted into a patient’s intestine.

This can help restore the balance of the patient’s gut bacteria, helping to fight off an overgrowth of C. difficile, which can cause diarrhoea, abdominal pain and bloating.

Faecal microbiota transplants (FMTs) are approved in the UK if “standard therapies fail to help with diarrhoea” caused by C. difficile, with a patient first being offered “different types and courses of antibiotics”.

With antibiotic resistance an ongoing threat and C. difficile infections recurring in around one in five patients, the health watchdog Nice analysed six studies with more than 7,300 participants between them.

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Results suggest a FMT is more effective at treating recurrent C. difficile than commonly-prescribed antibiotics like vancomycin and fidaxomicin.

In severe cases, an overgrowth of the bacteria can cause irreparable bowel damage or even death.

Illustration of the bacteria Clostridioides difficile. These rod shaped bacteria have flagella, which are used for motility. Clostridioides difficile (formerly known as Clostridium difficile) are anaerobic bacteria prevalent in soil. In humans, the bacteria can become established in the colon and disrupt the normal gut microbiota, particularly in people taking antibiotics. Toxins released by Clostridioides difficile can produce diarrhoea and inflammation.
C. difficile may overgrow after a patient takes antibiotics for another infection. (Stock, Getty Images)

Clostridioides difficile – formerly known as Clostridium difficile – can be tricky to treat, with the bacteria becoming less responsive to antibiotics over time.

While a FMT may sound off-putting, donors are first tested for an array of infections. They must also be free of medical problems and lead a healthy lifestyle.

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Previous research has suggested FMTs are between 80% and 90% effective at curing recurrent C. difficile.

The bacteria live harmlessly in the gut of around 3% of people, however, prolonged antibiotic use can cause them to overgrow.

This is due to antibiotics mistakenly killing “good bacteria” in the gut, allowing “bad” bugs to take hold.

Under existing guidelines, C. difficile treatment involves stopping the antibiotic that is thought to be behind the bacterial overgrowth.

In severe cases, a patient may then require a 10 to 14 day course of antibiotics that are known to kill C. difficile.

While most recover within two weeks, some require surgery to remove a damaged section of the bowel.

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In its report Faecal microbiota transplant for recurrent or refractory Clostridioides difficile infection, Nice points out a better cure rate among patients may reduce hospitalisations and overall ill-health.

FMTs may also shorten a patient’s hospital stay and drive down the risk C. difficile spores will be transferred between individuals.

The procedure is generally considered to be straightforward, with any side effects mild and fleeting.

Evidence is limited, however, when it comes to the treatment’s long-term efficacy.

Watch: What is a faecal transplant?

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