Fecal Microbiota Transplant for Recurrent C. difficile: Capsule Delivery Seems as Effective as Colonoscopy

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Fecal microbiota transplantation in capsule form appears as effective as delivery via colonoscopy for preventing Clostridium difficile recurrence, according to a noninferiority trial in JAMA.

Over 100 adults in Canada who had at least three episodes of uncomplicated C. difficile infection were randomized to receive fecal microbiota transplantation either orally (40 frozen capsules taken under direct observation) or via colonoscopy. Seven healthy volunteers provided all stool donations.

The proportion of treated patients without C. difficile recurrence at 12 weeks was the same in the two groups, at 96%. Quality-of-life measures increased significantly in both groups, while capsule recipients were more likely than colonoscopy recipients to describe their experience as "not at all unpleasant" (66% vs. 44%).

Treatment cost US$308 per patient in the capsule group versus US$874 per patient in the colonoscopy group.

The researchers conclude that frozen fecal capsules might be an effective approach to treatment.