Sarah McGill, MD, MSc a gastroenterologist and endoscopist, and Trevor Barlowe, MD, a gastroenterology fellow, have found that a newly-approved treatment for C. diff. infection, called fecal microbiota spores, may be associated with a particularly harmful rebound of infection, compared to traditional therapy. Their results were published in Clinical Gastroenterology & Hepatology.
For over a decade, fecal microbiota transplant (FMT) via colonoscopy has served as a traditional treatment for Clostridioides difficile (C. diff) infections, helping restore healthy gut bacteria by transferring stool from a donor into the patient’s colon. While generally safe, this method remains FDA-approved only for investigational use. In 2023, fecal microbiota spores received FDA approval. This pill-based treatment is taken three times daily after antibiotics to prevent recurrence of C. diff. UNC Medical Center in Chapel Hill, one of the few centers offering both therapies, began using the new oral treatment shortly after its approval, though comparative data between the two methods was previously lacking.
To fill this gap, Dr. McGill and Dr. Barlowe conducted a study using patient records from UNC Medical Center. They compared outcomes in adults treated with fecal spores versus those who underwent colonoscopy-based FMT. Both treatments were found to be effective in preventing recurrent C. diff infections. However, among the small number of patients who did experience a recurrence, those treated with fecal spores were more likely to develop severe disease. Specifically, two of the 28 patients who took fecal spores were hospitalized with fulminant C. diff infections, while none of the 102 patients who received FMT via colonoscopy developed this severe form.