Abstract
PurposeMetronidazol and vancomycin were long the two best options against Clostridioides (formerly Clostridium) difficile infections (CDI). Now, the cost of new drugs such as fidaxomicin directs us towards alternative treatment options, such as faecal microbiota transplant (FMT). Its effectiveness is similar to fidaxomicin. There are questions regarding its safety, but the biggest challenges are prejudice and inconvenience. Most protocols refer to FMT applied in the form of a solution. We investigated different modalities of FMT.MethodsInstead of using nasoenteric tubes or colonoscopy, we place frozen or lyophilised stool in non-coated, size “00”, hard gelatine capsules or enterosolvent, size “0” capsules.ResultsWe found that non-coated, size “00”, hard gelatine capsules are appropriate for conducting FMT. Capsules containing lyophilised supernatant with a low number of bacteria have been proven to be non-inferior to other FMT modalities. The primary cure rate in the supernatant group was 93.75%, and 66.67% in the sediment group. The overall cure rate was 82.14%. Depending on the protocol, 4–7 capsules are sufficient per patient. Capsules can be stored for up to one year at -20°C.ConclusionsFMT is a feasible alternative to antibiotic treatments in CDI. Our method makes the process flexible and less inconvenient to patients. Long storage time allows a consistent supply of capsules, while small volume and formulation make the procedure tolerable.
Highlights
Clostridioides difficile infections remain a major public health issue
It has already been proven that faecal microbiota transplantation (FMT) is more effective in Clostridioides difficile infection (CDI) than metronidazole and vancomycin and has similar efficacy to fidaxomicin
No major differences have been found between the FMT modalities
Summary
Estimating the burden of CDI is a challenging task, studies showed an annual cumulative incidence rate for all ages of 49.36 per 100 000 population (Balsells et al, 2019). Fidaxomicin is a successful antibiotic with respect to both effectiveness and recurrence rate (Madoff et al, 2019). A network meta-analysis concluded the cure rates and recurrence rates of the aforementioned antibiotics as follows: in severe CDI, metronidazole had a clinical cure rate of 76%, while the cure rate for vancomycin varied between 90% and 97%. Fidaxomicin was found non-inferior to Vancomycin (91,7% versus 90,6%, respectively) in that comparison, and showed significantly lower rates of recurrence 12.7% versus 26.9%, respectively) (Okumura et al, 2020). The European Consensus Conference on FMT in clinical practice board has recommended FMT as treatment option for both mild and severe recurrent CDI (rCDI) (Cammarota et al, 2017). The strength of recommendation for the first episode of CDI was described as weak
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
