Recurrent Clostridium difficile colitis: the only validated indication

Recurrent Clostridium difficile colitis is the first cause of treatment-related diarrhea and affected over 450,000 Americans in 2011, of which 30,000 died. In France, 1800 deaths were associated to C. difficile infection in 2014². An estimated 5% of overall mortality in hospitalized patients is attributable to this bacterial strain.

Until the 1990s, C. difficile colitis was a relatively rare infection which was not considered a health hazard: an antibiotic treatment was enough to get rid of it. But in a 20-year period, the frequency of this disease more than doubled, while the efficacy of the antibiotics therapy dropped to a 20-30% success rate^8,9. The bacterium is becoming increasingly resistant to antibiotics. It was not until the start of the 2000s and the sequencing of C. difficile genome when a particularly virulent strain was identified. It is resistant to antibiotics and able to produce 10 times the amount of toxins usually secreted by this bacterium.

Beware of relapse with repeated antibiotic courses!

Infection generally occurs after the destruction of the gut microbiota by repeated courses of antibiotics. C. difficile, which is present as resting spores in the colon, proliferates and changes to produce toxins that cause inflammation and diarrhea. Paradoxically, this infection is treated with antibiotics, which progressively exacerbate the gut microbiota disruption at each additional treatment course³ thus leading to a 35% rate of relapse².

FMT should be preferred to antibiotics for recurrent cases

In 1958, the surgeon Ben Eiseman published 4 cases of pseudomembranous colitis that were cured with FMT and sparked interest in this method. Several articles described its efficacy to treat the recurrent form of this disease. But the true turning point came in 2013 with the publication of the first clinical trial in humans. This trial was designed with a robust methodology and demonstrated the therapeutic superiority of FMT over antibiotic therapy to treat recurrent and drugresistant forms of C. difficile infections.