Fecal transplantation, vancomycin superior for recurrent C. diff
A combination of fecal microbiota transplantation and vancomycin was superior to fidaxomicin or vancomycin alone for the treatment of recurrent Clostridium difficile infection, according to research published in Gastroenterology.
Christian L. Hvas , MD, PhD, of the department of hepatology and gastroenterology at Aarhus University Hospital in Denmark, and colleagues wrote that while previous studies have shown the benefit of FMT for the treatment of CDI, it has not been compared with oral antibiotics.
“The occurrence of CDI is increasing both in hospital settings and in the community, and the disease poses a serious public health challenge,” they wrote. “Patients who suffer one recurrent CDI (rCDI) have a 45% risk of further recurrence. In patients with multiple recurrences, the risk of further recurrence approaches 75%.”
Researchers studied 64 adult patients with rCDI in a single-center, randomized trial to compare FMT with vancomycin and fidaxomicin. They randomly assigned patients to receive either FMT after 4 to 10 days of vancomycin (n = 24), 10 days of fidaxomicin (n = 24), or 10 days of vancomycin. The main outcome of the study was combined clinical resolution and a negative result from a polymerase chain reaction test for C. difficile toxin 8 weeks following completion of treatment.
Investigators observed clinical resolution and negative C. diff test in 17 patients who underwent vancomycin followed by FMT (71%), eight patients who received fidaxomicin (33%), and three patients given only vancomycin (19%; FMT vs. fidaxomicin, P = .009; FMT vs. vancomycin, P = .001). They found that 22 patients who received FMT achieved the study’s secondary outcome of clinical resolution (92%) compared with 10 patients who received fidaxomicin (42%) and three patients who received vancomycin (19%).
If patients experienced recurrence following treatment, investigators offered them rescue treatment with vancomycin followed by FMT. Results between patients who received rescue FMT or FMT as initial therapy were not significantly different.
“[FMT with vancomycin] was superior to both fidaxomicin and vancomycin monotherapies for rCDI, with regard to both combined clinical and microbiological resolution and clinical resolution alone,” Hvas and colleagues wrote. “Resolution rates similar to that in patients randomized to FMT were found in patients who had been randomized to antibiotic treatment and were offered rescue FMT following CDI recurrence and in patients who could not be randomized and were offered FMT off protocol.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.