Alternative Method to Treat Recurrent Clostridium Difficile

This story is part of MD Magazine's Year-End Recap series.

Click here for Part 1, a look into the success of ketamine as a multifaceted therapy.Click here for Part 2, a look at the future of Alzheimer's Disease therapies.

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For patients with Clostridium difficile (C. diff) persistent and recurrent disease hamper attempts at eradication of the infection, however, escalating levels of treatment and novel therapies are being utilized and developed to potentially treat it.

The past decade has brought increased incidence especially in hospitals. As modern medicine has allowed people to live longer, the aging population becomes more vulnerable, and C. diff is a result of hospitalizations and ongoing increase of vulnerability to it.

The increase in incidence means the demand of therapies to treat recurrent infection also rises. At least 20% of patients who are initially diagnosed with C. diff, have a recurrent infection within 8 weeks.

When the C. diff infection first began, it was limited to a narrow spectrum of antibiotics, particularly clindamycin, however, overtime, a broader spectrum of antibiotics has led to its considerable growth, particularly in hospital settings for older patients, and post-operative patients — which often leads the problem of recurrence.

Antibiotics continue to remain a top risk factor for community associated infection in adults, as studies have shown that as much as 30—50% of all antibiotic use is inappropriate, which highlights the importance of reasonable outpatient prescribing.

“A big problem these days is that many of these patients have to be re-treated, and as you have a greater number of people getting it, then you have a greater number of people having resistance to C. difficile,” Douglas Drossman, MD, president, Rome Foundation, told MD Magazine in an interview. “I think the new kid on the block is looking at fecal transplant, because that’s been shown to be very effective for these patients who are refractory to repeated treatment, usually vancomycin.”

Fecal microbiota transplants (FMT) delivered by colonoscopy, are an effective therapy to treat C. diff, however, in November, a Canadian clinical trial found that FMT is just as effective delivered by capsule.

Study findings could broaden and revolutionize the use of FMT, restoring the healthy balance of bacteria living in a patient with C. diff.

“This will transform the way people think about how we deliver fecal microbiota transplant,” Dina Kao, MD, lead study author, associate professor, University of Alberta Faculty of Medicine and Dentistry, gastroenterologist, Alberta Health Services, said in a statement. “Capsules have numerous advantages over colonoscopy. They are non-invasive, they’re less expensive, they don’t have any of the risks associated with sedation and they can be administered in a doctor’s office.”

The oral capsules containing frozen donor bacteria were shown to be 96.2% effective in treating the infection, the same success rate as those receiving transplant by colonoscopy.

Compared to FMT delivered by colonoscopy, FMT delivered by capsules are non-evasive, and less expensive, costing $308 per patient compared to $874 per patient undergoing a colonoscopy.

“I think it’s (FMT) going to make a difference in the resistant strains, but I don’t think it’s cost effective, or even medically reasonable to do that for everybody,” Drossman said.

“Where most patients, as I said about 80% who respond will respond and that’s it. But for those who recur, there are protocols that allow you to alternate the drugs or taper them down, but in the 5—10% or so where that doesn’t happen, that’s where you have a good treatment now.”

The noninferiority of the oral capsules can be beneficial in future pursuits for less invasive, economic procedures that are beneficial to patients.