In the treatment of infectious Clostridium difficile colitis which can occur after antibiotic therapy, faecal transplantation to restore normal intestinal flora can be done orally
In adults with recurrent infectious colitis Clostridium difficile, fecal transplant through oral capsules is as effective as transplant through colonoscopy in preventing recurrence. Results at 12 weeks of evaluation are published in JAMA.
In this randomized non-inferiority study of 116 adults with recurrent post-antibiotic infectious colitis at Clostridium difficile, the proportion of patients without recurrence at 12 weeks is 96.2% after a single treatment in the group transplanted by capsules and in that treated by colonoscopy, respecting the predefined non-inferiority margin of 15%.
The oral route has many advantages
The frequency of minor adverse events was 5.4% in the capsule transplantation group compared with 12.5% in the colonoscopy transplantation group. There is no significant difference between the groups for the improvement of the quality of life and the 2 routes of administration are therefore equivalent in terms of efficacy-tolerance ratio.
A significantly higher proportion of capsule transplant patients rated their experience as “not at all unpleasant” compared to colonoscopic transplantation (66% vs 44%, difference, 22% [IC 95%, 3% -40%], p = 0.01).
A recurrent infection that is difficult to treat
Infection with Clostridium difficile is the main cause of infectious diarrhea after antibiotic treatment. The first-line treatment for this infection is antibiotics, but 10% to 30% of patients will have a recurrence. The risk of recurrence approaches 60% after the third treatment.
In this case, faecal transplantation is the most effective treatment for recurrent infectious colitis with Clostridium difficile. According to studies, its effectiveness varies between 60% and 90% after a single transplant attempt. The administration method considered to be the most effective for the prevention of recurrence is administration by colonoscopy (90%), before the upper gastrointestinal tract (80%), but this is on the basis of uncontrolled studies. .
Faecal transplantation of gut microbiota through an oral capsule is as effective as endoscopically in preventing recurrence of infectious colitis with Clostridium difficile. However, it is best not to bite into the capsule when swallowing it.
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