Mayo Clinic physician suggests fecal transplants as non-pharmaceutical for antibiotic-resistant bacteria
Transplanting human donor fecal microbiota into the colon of a patient infected with Clostridiodes difficile (C. diff) may be the best treatment for cases where targeted antibiotics are not effective, according to a new article published in the Journal of the American Osteopathic Association.
The standard Food and Drug Administration (FDA)-approved treatment for C. diff is a course of oral vancomycin, an antibiotic. However, the medications used to eliminate C. diff can perpetuate the infection by killing off beneficial microbes. Newer antibiotics that more specifically target C. diff have been developed but they can be expensive, said Robert Orenstein, DO, an infectious disease specialist at the Mayo Clinic in Rochester, Minnesota, and lead author of the article.
"Think of your gut as a forest and C. diff as a weed," said Orenstein. "In a thriving forest, weeds barely get a foothold. But if you burn the forest down, the weeds are going to flourish."
Unlike antibiotics, fecal transplants or microbial replacement therapies repopulate the gut with a diverse group of microbes that may block the C. diff spore from germinating and propagating disease via its toxins. Transplants have several delivery methods, including enemas, capsules, and direct instillation, to replace the diverse flora that maintain health and improve metabolism.
C. diff is the most common healthcare-acquired infection in the United States. It affects nearly half a million patients each year and becomes a recurring infection for nearly a third of them. If untreated, C. diff can lead to sepsis and death, according to the Centers for Disease Control and Prevention (CDC).
Currently, there are no FDA-approved fecal transplant products and performing fecal transplants is considered an investigational procedure. Orenstein notes there are several companies with products in Phase 3 clinical trials that could come to market as early as 2020. For this reason, he said he strongly urges healthcare providers to refer patients with recurrent C. diff for these trials rather than for fecal transplants. In the meantime, the FDA reserves fecal transplants for patients who have experienced a second recurrence or third episode of C. diff infection.
C. diff is common in healthcare settings and public spaces and rarely causes problems in people with healthy gut microbiota and immune systems, according to researchers. However, people who are already ill and taking antibiotics, chemotherapy, or proton pump inhibitors, which all greatly disrupt the gut ecosystem, are at risk. Elderly patients are especially vulnerable, Orenstein said.
Orenstein expects the new treatment options will improve outcomes but says physicians need to assume greater responsibility for prevention.
"One of the most effective things physicians can do is become more responsible with antibiotic prescriptions," Orenstein said. "That means only prescribing when they are clearly indicated, not for colds or viral sinus infections. We also must be especially judicious with elderly patients."