Poo transplants better than antibiotics for diarrhoea

Researchers have found that poo transplants are more effective at treating diarrhoea than antibiotics; however, they’re still determining the best method to administer the transplant.

The authors found that faecal microbiota transplantation (FMT) is more effective at treating Clostridium difficile-associated diarrhoea (CDAD) than the antibiotic vancomycin or placebo. Their systematic review was published in the Medical Journal of Australia. 

The authors, led by Professor Paul Moayyedi, director of the Division of Gastroenterology at McMaster University in Canada, noted that over the past 20 years, CDAD incidence worldwide has more than doubled, and outbreaks have been associated with greater morbidity and mortality — although less so in Australia.

FMT has emerged as an important approach to treating CDAD resistant to antibiotic therapy, the authors wrote, although until now the quality of evidence underpinning official guidelines has been less than optimal.

As a result, the authors undertook a systematic review of randomised controlled trials (RCTs) of FMT in patients with CDAD. They identified 10 such trials that evaluated the treatment of 657 CDAD patients who had not responded to antibiotic treatment, or for whom the disease had recurred after at least one course of antibiotics.

They found that the transplants were statistically more effective in curing CDAD, writing, “FMT was more effective in European than in North American trials, and when administered by the naso-duodenal or colonoscopy routes rather than by enema.”

The authors also looked at trials that compared different preparations and ways of administering an FMT. They found that frozen or thawed transplants were more convenient for donors and reduced “the burden on a donor to supply a sample on the day it is needed”.

However, they believe further investigation around the best method of administering an FMT is required, citing the risk of aspiration with naso-duodenal applications and a small risk of perforation via colonoscopy, which is more significant in patients with severe disease.

“It is therefore important that an adequately powered RCT compares the efficacy of FMT by enema with that by colonoscopy,” the authors concluded.

Image credit: ©stock.adobe.com/au/Piumadaquila