What is a fecal transplant, and how is it used to treat patients?

Fecal microbiota transplant, now referred to as intestinal microbiota transplant (IMT), involves transplanting the healthy microbial population from a healthy person to another person whose intestinal bacteria have been depleted by antibiotics. It is an important option for C. difficile infection not responding to antibiotics that are the standard of care for this infection.

The problem with the antibiotics used to treat C. difficile infections is that they kill not only C. difficile but also “good” bacteria. Dysbiosis, or abnormal microbe populations, also occurs in other disorders, including inflammatory bowel disease, cirrhosis, obesity, diets high in fats and sugars and even neurologic conditions.

At this time, the U.S. Food and Drug Administration considers IMT to be investigational and allows its use only in approved clinical research trials and in C. difficile infections not responding to standard-of-care antibiotics.

IMT can be delivered to the colon during a colonoscopy or by pills designed for colon delivery. There are two FDA-approved clinical drug trials in progress evaluating pill formulations for C. difficile infections. At UVa Health, I am working with colleagues from Infectious Disease to participate in a drug trial to evaluate one potential option. Open Biome, a not-for-profit stool bank, is our source for IMT delivered by colonoscopy.

For more information about the clinic, visit uvahealth.com/locations/profile/complicated-difficile-clinic.

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Dr. R. Ann Hays is director of the Complicated C. difficile Clinic at the University of Virginia Health System.

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