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Fecal Bacteriotherapy Effective for Treating Relapsing Clostridium Difficile Infection

The case report focuses on a two-year old who was not responsive to probiotics or intensive antibiotic treatment.

A study recently published online in Pediatrics reports on the case of a two-year old child with relapsing Clostridium difficile infection (CDI) in which fecal bacteriotherapy was used for treatment.

According to the researchers, who were all from Massachusetts General Hospital and Harvard Medical School and led by George Russell, MD, MS, of the division of gastroenterology and the department of pediatrics, the two year-old was suffering from relapsing CDI that was caused by the epidemic strain BI/NAP1/O27 and not responsive to Saccharomyces boulardii and Lactobacillus rhamnosus GG probiotics and to intensive therapy with traditional (metronidazole, vancomycin) and experimental (rifaximin, nitazoxanide) antibiotics, “despite its apparent antimicrobial-susceptible phenotype.”

The researchers designed a protocol to safely administer fecal bacteriotherapy through a temporary nasogastric tube “after excluding other infectious causes of diarrhea and inflammatory bowel disease.” The procedure was deemed a success, with the team reporting that they demonstrated, for the first time, “that fecal transplantation is practical and effective for treating relapsing CDI in a young child.”

Lewis R. First, MD, MS, editor of Pediatrics, wrote about the results of the study on the Pediatrics blog, stating that “it is reassuring to know that, thanks to fecal bacteriotherapy, everything comes out fine in the end with this patient, and that hopefully this case will lead to more definitive randomized trials to truly determine the safety and efficacy of this therapy.”

Although the team feels positive about the results of the study, they do recommend that the strategy “be reserved for complicated cases of CDI that fail conventional therapy until randomized studies can confirm the safety and effectiveness of fecal bacteriotherapy in children.”