IMPORTANT: Fecal Transplants Outperform Antibiotics In Clinical Trial

01.18.13 5 years ago 4 Comments

We are nothing if not exceptionally mature.

If you’ve listened to any random episode of the FilmDrunk Frotcast, you already know that fecal transplants are totally rad. These procedures, in which feces from a person with healthy gut bacteria is transplanted into a patient with an unhealthy bacterial profile, have shown significant promise but haven’t been studied in a randomized clinical trial . . . until now. Over 500 people with the typically antibiotic-resistant bacterium Clostridium difficile have been treated with fecal transplants in the past 50 years, but all evidence until recently has be anecdotal. Ed Yong writes (in Nature) about the first fecal transplant randomized clinical trial.

The first results from a faecal transplant trial have been published in the New England Journal of Medicine, and they are a resounding vindication for the technique. The infusions of faeces cured 94% of patients who received it (15 out of 16), all of whom had already suffered at least one relapse of C.difficile. By comparison, the standard antibiotic — Vancomycin — only cured 27% of patients (7 out of 26). The difference was so great that the Dutch team behind the study had to stop the trial early. Everyone eventually received the faecal transplants. [NERS]

And YOU get a fecal transplant!

And YOU get a fecal transplant!


Anyway, the only negative side effects (constipation or diarrhea shortly after the transplant) were rare and preferable to having C. diff. There are some interesting things to note about this study. Fecal transplants are usually done via an enema, also known in scientific nomenclature as “butt-chugging” the donor feces. Els van Nood and Josbert Keller at the University of Amsterdam instead opted to thread a tube through the nose and into the small intestine. (A different clinical study using the enema method is in progress with Lawrence Brandt at the Albert Einstein School of Medicine.)

Els Van Nood noted it may be easier to gain regulatory approval if the feces used came from pre-screened healthy donors whose feces was frozen until needed. (By all means, use the break room refrigerator.) A new clinical trial is underway comparing frozen and fresh fecal samples for effectiveness. Els Van Nood also noted that some of her test subjects expressed a desire to be in the fecal transplant group instead of the antibiotic group, with older patients being the most adamant.

It seems many people are enthusiastic about fecal transplants. Jim Romenesko received an email from an unnamed editor who says a fecal transplant story in The New York Times is on track to possibly become the most-emailed NYT article of all time. Someday, you can tell your grandkids that you were alive when articles about poop transplants were not yet the most-emailed Times articles. Those were dark times indeed.

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