New guidelines support fecal-microbiota transplant as 2nd-line C. diff treatment — 6 insights

New guidelines from the British Society of Gastroenterology and Healthcare Infection Society recommended physicians use fecal-microbiota transplant as a second-line treatment for recurrent or refractory Clostridium difficile infection only, Medscape reports.

Here's what you should know:

1. Researchers reviewed several potential indications for FMT, including CDI and non-CDI indications.

2. Researchers recommend FMT for recurrent or refractory CDI but only as a second-line treatment. Researchers instead recommend antimicrobial and/or antitoxin therapy prior to FMT.

3. Finally, researchers said FMT recipients should receive routine follow-up. However, if initial FMT fails, researchers did recommend repeat FMT.

4. All FMT should be sourced from a centralized stool bank, collected from healthy, unrelated donors, researchers concluded. Frozen material should be favored over fresh material.

5. Concerning recurrent CDI and inflammatory bowel disease, patients should understand there is a small risk FMT will worsen IBD.

6. Fidelma Fitzpatrick, MD, of The Royal College of Surgeons and Beaumont Hospital in Dublin, Ireland, said while FMT has a growing evidence base of effectiveness, the lack of regulation is holding back heightened recommendations.

She said, "This is a rapidly evolving area, and it is likely as new evidence emerges further indications for FMT will become apparent."

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