Based on a small study, Amsterdam researchers find that fecal transplantation works better than vancomycin therapy to treat recurrent Clostridium difficile infections, which they report in The New England Journal of Medicine.
Forty-three patients were randomly assigned to receive donor feces, vancomycin, or vancomycin and bowel lavage treatment. Of the 16 patients who received donated feces, 13 were cured after their first treatment round, and 15 of the 16, or nearly 94 percent, were cured overall. In the vancomycin-only group, four of the 13 patients were cured, and, in the vancomycin plus lavage group, three of the 13 patients were cured.
Ed Yong at Not Exactly Rocket Science notes that the results were so impressive that the team stopped the study early and that all the patients eventually received the treatment.
The treatment is thought to work by altering the composition of the patients' gut microbiome. "The mechanism underlying the efficacy of donor-feces infusion is probably the reestablishment of the normal microbiota as a host defense against C. difficile," the researchers note in their paper, adding that "the fecal microbiota in patients with C. difficile infection had a reduced bacterial diversity, as compared with healthy persons, extending previous observations. Infusion of donor feces resulted in improvement in the microbial diversity, which persisted over time."
Fecal transplants have been used before to treat C. difficile infections, but there have been few controlled experiments, The New York Times adds.
"Those of us who do fecal transplant know how effective it is," Colleen Kelly, a gastroenterologist at the Women's Medicine Collaborative in Providence, RI, tells the Times. "The tricky part has been convincing everybody else."
The indiscriminate use of
The indiscriminate use of antibiotics to treat bacterial infections is rather akin to the use of chemotherapy drugs that target DNA synthesis or microtubule dynamics to treat cancer. One of the first casualties of such cancer treatments is the wiping out of the immune system, which provides the human body's best defence against the spread of cancer. In the case of general antibiotics, the destruction of the resident flora of bacteria in the average person, which can number in the trillions of bacteria, is the collateral damage that can make a bad situation even worse, especially if the culprit pathogenic bacteria is resistant to the antibiotic.
Some 5000 or more types of bacteria exist with a person's resident flora. They actually produce and secrete anti-bacterial peptides, as well as compete for space and nutrients with pathogenic bacteria, and this facilitates the establishment and maintenance of a healthy gut that protects the host. It seems that the multi-cultural" society of bacteria, technically outside the inside of our bodies, is amazingly harmonious in view of its diversity. Pathogenic bacteria that pose a threat to the resident flora are likely to be commonly and successfully kept in check by both the resident flora and the body's immune system.
The introduction of transplanted fecal material at the bottom end provides for restoration of the resident flora just as does the eating of probiotic yogurt at the front end. As a practice that can aid patients with recurrent Clostridium difficile infections, fecal transplantation might be the best strategy at this time. However, as with improved cancer therapy, it would be better to develop drugs that are actually more highly selective for Clostridium and other pathogenic bacteria. The growing availability of the genomes of these and other bacteria will surely aid such efforts.