3 years ago

Clinical practice and infrastructure review of fecal microbiota transplantation for Clostridium difficile infection.

Kelly BJ, Tebas P
A significant proportion of C. difficile infection (CDI) cases recur after completion of antibiotic therapy, and antibiotic cure rates diminish with each recurrence of CDI. Fecal microbiota transplantation (FMT) is an effective therapy for recurrent FMT, which otherwise requires prolonged or indefinite antibiotic treatment. FMT is performed by introducing the fecal microbial community obtained from a healthy donor or pool of donors into the stomach, small intestine, or colon of a patient with CDI. Multiple clinical trials support the utility of FMT in treating recurrent CDI, and CDI treatment guidelines now include consideration of FMT at the third CDI recurrence. However, there remain significant challenges to incorporating FMT into clinical practice: (1) Methods of fecal bacterial community processing vary, as do methods of FMT administration. (2) The optimal dosing strategy and expected benefit of FMT for refractory CDI, particularly for severe and severe-complicated cases, are uncertain. (3) The Food and Drug Administration (FDA) considers FMT an investigational treatment. And (4) insurance reimbursement for FMT usually falls short of FMT administration costs. In the setting of rising C. difficile incidence and growing evidence for FMT efficacy, the demand for FMT has increased. However, uncertainty surrounding optimal FMT preparation and administration methods, FDA oversight, and insurance reimbursement presently limits the clinical practice of FMT.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28923757

DOI: PubMed:28923757

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