Sixty seconds on . . . faecal transplants

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2152 (Published 05 September 2022)Cite this as: BMJ 2022;378:o2152

Elisabeth Mahase

Everything Comes Down to Poo

Hundreds of people with recurrent bacterial infections could be treated using gut bacteria taken from a healthy donor’s poo, after the National Institute for Health and Care Excellence (NICE) recommended the treatment for recurrent Clostridium difficile infections.1

A gut reaction

C difficile infections can occur when the balance of bacteria in the bowel changes, and can lead to diarrhoea. Infections range from mild to life threatening and although they are often the result of taking antibiotics, they are also initially treated with antibiotics.

(Gram) positive news

NICE has said a faecal microbiota transplant (FMT) will now be offered to people in England who have had two or more C difficile infections without successful treatment. The aim is to restore a healthy population of bacteria by delivering intestinal bacteria to the stomach or colon—either through an inserted tube or by an oral pill.

What’s the evidence?

Clinical evidence presented to NICE suggests a FMT could resolve up to 94% of infections. In 4 out of the 5 randomised controlled trials they looked at—which included 274 adults—more infections were resolved with FMT than with antibiotic treatment. In the other trial, no difference was seen.

Feeling flush

NICE has said the treatment could save the NHS thousands of pounds, with modelling showing that FMT treatment is cheaper than almost all the antibiotic treatment options. As a bonus, the recommendation could also lead to a reduction in antibiotic use. NICE’s interim director of medical technology Mark Chapman said, “Use of this treatment will help reduce the reliance on antibiotics and in turn reduce the chances of antimicrobial resistance.”