Better Than Antibiotics – Stool Transplants Show Promising Results in Treating Life-Threatening Infections

Gut Infection Illustration

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Clostridioides difficile (C. diff) is a sort of bacterium that may trigger an infection within the intestine, resulting in signs similar to diarrhea, belly ache, and fever. C. diff infections are sometimes a results of an imbalance within the intestine microbiome, which might happen after taking antibiotics.

According to a latest Cochrane Review, stool transplantation has confirmed to be a simpler methodology of treating Clostridioides difficile an infection as in comparison with commonplace antibiotic therapy. 

According to a latest Cochrane Review headed by a professor at Upstate Medical University, stool transplantation has been discovered to enhance the speed of restoration from Clostridioides difficile (C. diff) an infection, a critical situation that may trigger life-threatening diarrhea, in comparison with commonplace antibiotic therapy. The evaluation revealed that 77% of sufferers who underwent a stool transplant didn’t expertise a reinfection inside eight weeks, whereas solely 40% of those that acquired antibiotics alone achieved the identical end result.

C. diff is a bacterium that may trigger life-threatening diarrheal sickness in people with an unhealthy combination of intestine micro organism, often called dysbiosis. The most typical reason for dysbiosis is therapy with antibiotics, and whereas antibiotics may be very efficient in opposition to bacterial infections, they’ll additionally hurt the useful micro organism colonizing the intestine, often called the intestinal microbiome. Usually, this ecosystem of “good” micro organism recovers rapidly, however often “bad” species like C. diff take over and cause serious diarrhea.

The standard treatment of C. diff infection includes antibiotics, which may further exacerbate dysbiosis. This can lead to a vicious cycle of brief treatment effect followed by a recurrent infection. This happens in nearly a third of infected individuals. According to the CDC, every year there are around a quarter of a million C. diff infections in the US alone, causing approximately 12,000 fatalities.

Transplanting healthy donor stool into a gut with dysbiosis is intended to balance the gut microbes and reestablish a healthy microbiome, thus significantly reducing the risk of C. diff recurring. Stool donation operates much the same way as blood donation. Donors are screened for diseases and infections before they can donate their stool. The stool can be transplanted via colonoscopy, nasogastric or nasoduodenal tube, enema or via a capsule. The US Food and Drug Administration has recently approved a stool transplant product for the prevention of the recurrence of C. diff that can be administered as an enema.

The new Cochrane Review, led by pediatric gastroenterologist Aamer Imdad MBBS, examined data from six clinical trials with a total of 320 adults that assessed the efficacy and safety of stool transplantation for the treatment of repeated C. diff infection. Two studies were conducted in Denmark, and one each in the Netherlands, Italy, Canada, and the United States. Most of the included studies compared stool transplantation with a standard antibiotic treatment using vancomycin, which is commonly used for this kind of infection.

The review found that stool transplantation leads to a larger increase in resolution of repeated infections of C. diff than other treatments studied, as well as a decrease in side effects when compared with standard treatment using antibiotics.

“After a person with a C. diff infection gets treated with antibiotics, there is about a 25 percent chance that they will have another episode of C. diff infection in the next 8 weeks”, Imdad said. “The risk of recurrence increases to about 40 percent with the second episode and to nearly 60 percent with the third episode. So, once you are in this cycle, it gets more and more difficult to break out of it. Stool transplants can reverse the dysbiosis and thus decrease the risk of recurrence of the disease.”

A second Cochrane Review, also led by Dr. Imdad, looks at the use of stool transplants for the treatment of inflammatory bowel disease (IBD), a term mainly used to describe two conditions: ulcerative colitis and Crohn’s disease. The review shows promising results for ulcerative colitis; however, the data is not conclusive yet. Results for Crohn’s disease are even less conclusive. More research will be required before stool transplants can be considered for the treatment of IBD.


“Fecal microbiota transplantation for the treatment of recurrent Clostridioides difficile (Clostridium difficile)” by Nathan Zev Minkoff, Scheherzade Aslam, Melissa Medina, Emily E Tanner-Smith, Joseph P Zackular, Sari Acra, Maribeth R Nicholson and Aamer Imdad, 25 April 2023, Cochrane Database of Systematic Reviews.
DOI: 10.1002/14651858.CD013871.pub2

“Fecal transplantation for treatment of inflammatory bowel disease” by Aamer Imdad, Natasha G Pandit, Muizz Zaman, Nathan Zev Minkoff, Emily E Tanner-Smith, Oscar G Gomez-Duarte, Sari Acra and Maribeth R Nicholson, 25 April 2023, Cochrane Database of Systematic Reviews.
DOI: 10.1002/14651858.CD012774.pub3

Imdad collaborated with doctors around the country on both studies, including Nathan Zev Minkoff, a graduate from the Norton College of Medicine, Upstate students Natasha Pandit and Muiz Zaman, Class of 2023 in the Norton College of Medicine and Melissa Medina, Class of 2026 in the Department of Public Health and Preventative Medicine, on the C-diff study. The other collaborators included Dr. Maribeth Nicholson and Dr. Sari Acra from Vanderbilt University Medical Center, Dr. Scheherzade Asalam from University of Nebraska, Dr. Emily E Tanner Smith from University of Oregon, Dr. Oscar Gomez from University of Buffalo and Dr.  Joseph Zackular from University of Pennsylvania.