Clostridium difficile (C. diff) causes a virulent bacterial infection that leads to inflammation of the colon and severe diarrhea. Those at highest risk for the illness include adults age 65 and older (especially those who live in nursing homes or have been hospitalized) and people who take antibiotics unnecessarily or have a serious illness or a weakened immune system. Tragically, C. diff infection sickens up to half a million Americans and kills nearly 30,000 each year.

Part of what makes the condition so dangerous is its tendency to strike more than once…it comes back in about 30% of people. Recurrent C. diff infection has traditionally been treated with an antibiotic—the most commonly used are vancomycin (Vancocin) and fidaxomicin (Dificid)—but recent studies show that transplanting gut bacteria from a healthy donor to restore the natural balance of the patient’s gut microbiome is an effective alternative.

In fact, studies have shown that this treatment, known as fecal microbiota transplantation (FMT), has a better cure rate and a lower recurrence rate than antibiotics. However, many professional guidelines still recommend antibiotics as the first-line treatment for recurrent C. diff infection despite the research showing that FMT is more effective.

Now: Researchers at the University of Birmingham in the United Kingdom have found that FMT is not only more effective at treating recurrent C. diff infection, but also is less costly than antibiotic treatment.

Study details: To analyze the effectiveness and cost of treatment for recurrent C. diff infection, the investigators used randomized controlled trials, observational studies and expert opinions focusing on patients over age 65 who were hospitalized due to the infection. Four treatments were compared—FMT administered by colonoscopy…FMT administered via a nasogastric tube, which is passed through the nose into the stomach…use of the antibiotic fidaxomicin…or the antibiotic vancomycin. The study, which was published in the online medical journal EClinicalMedicine, found that…

  • FMT by colonoscopy was slightly more effective than FMT by nasogastric tube but significantly more expensive.
  • FMT by nasogastric tube was the least expensive treatment and more effective than antibiotics.
  • Fidaxomicin was less effective and more expensive than either type of FMT.
  • Vancomycin was the most expensive and least effective treatment.

Based on these comparisons, FMT by nasogastric tube came out on top as a treatment option for recurrent C. diff infection due to its low cost and effectiveness. Note: FMT also can be administered by other methods, such as an oral capsule or enema, but these options were not included in the study. For all delivery methods, FMT uses a stool sample from a donor who is screened for any health conditions that could be spread through feces. The donor’s stool is emulsified, filtered and sometimes frozen to preserve healthy gut bacteria.

Bottom line: FMT is more effective—and less costly—than the two antibiotics most commonly used to treat C. diff infection. The researchers hope that this study may help change guidelines that continue to recommend antibiotics as a first-line treatment. The use of FMT also may provide long-term savings by cutting down on the number of days that C. diff patients must be hospitalized.

Source: The study “Economic Evaluation of Faecal Microbiota Transplantation Compared to Antibiotics for the Treatment of Recurrent Clostridioides difficile Infection” led by researchers at the University of Birmingham, UK, and published in EClinicalMedicine.