Metronidazole is a standard treatment for C. difficile diarrhea, but it is not always effective and sometimes gives rise to antibiotic resistance. Juul and colleagues1 performed a proof-of-concept trial to evaluate the use of fecal microbiota transplantation as treatment for primary C. difficile infection. The trial randomized adult patients with acute C. difficile to oral metronidazole or fecal microbiota transplantation (one 60-ml enema of anaerobically cultivated human intestinal microbiota). The primary end point was clinical cure with no evidence of recurrence of C. difficile infection by day 70. A clinical cure was observed in 5 patients (56%; 95% confidence interval [CI], 21 to 86) in the transplantation group and in 5 in the metronidazole group (45%; 95% CI, 17 to 77) (exact p=1.00). No serious treatment-related adverse events were reported in either group. While small, this trial suggests fecal microbiota transplantation may be an alternative to metronidazole for patients with C. difficile infection. Larger studies are ongoing.
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Read more at: Juul FE, Garborg K, Bretthauer M, Skudal H, Øines MN, Wiig H, Rose Ø, Seip B, Lamont JT, Midtvedt T, Valeur J, Kalager M, Holme Ø, Helsingen L, Løberg M, Adami HO. Fecal Microbiota Transplantation for Primary Clostridium difficile Infection. N Engl J Med. 2018 Jun 2.