- Repeated fecal microbiota transplantation (FMT) along with vancomycin (Vancocin) for refractory Clostridioides difficile infection (CDI) achieved 100% cure vs single transplant in this randomized controlled trial.
- Patients with pseudomembranous colitis also responded well to multiple FMT.
Why this matters
- Single FMT infusions for severe CDI and pseudomembranous colitis may be effective, but recurrences often follow.
- Small studies suggest high cure rates for severe or recurrent CDI with repeated FMT infusions.
- Single- vs multiple-FMT protocol:
- Cure: 75% vs 100%, in both per-protocol and intention-to-treat analyses (P=.01).
- No serious adverse events.
- 7 patients not initially cured with a single infusion had pseudomembranous colitis, and 4 had severe-complicated CDI.
- All were eventually cured with repeated off-protocol FMT.
- Open-label, randomized controlled trial, single center in Rome.
- 56 adults with severe CDI refractory to antibiotics randomly assigned to:
- Single FMT, then subsequent 14-day vancomycin course, vs
- ≥2 FMTs, repeated every 3 days among subgroup with pseudomembranous colitis until pseudomembrane resolved, with concomitant 14-day vancomycin course.
- Outcome: clinical cure of refractory CDI (improvement within 1 week of FMT, diarrhea resolved by 8 weeks).
- Funding: Not disclosed; authors report no personal or funding interests.
Small unblinded trial.