• Posted June 20, 2025

Fecal Transplant Potential First-Line Treatment For C. Difficile Infection

FRIDAY, June 20, 2025 (HealthDay News) — A fecal transplant performs as well as antibiotics in treating people with a bacterial infection that can cause life-threatening diarrhea, a new study says.

People who received a single fecal transplant via enema recovered slightly better from a Clostridioides difficile infection than those who took an oral antibiotic four times a day for 10 days, researchers reported June 17 in the Annals of Internal Medicine.

Fecal microbiota transplantation (FMT) actually performed more than 5 percentage points better than the antibiotic vancomycin, “which, although not statistically significant, indicates that FMT has the potential to change the current practice of antibiotic therapy and may establish FMT as a first-line treatment for primary C. difficile infection,” concluded a team led by Dr. Frederik Emil Juul, a postdoctoral fellow with the University of Oslo in Norway.

These findings were powerful enough that an independent Data Safety Monitoring Board recommended concluding the clinical trial early, researchers said. 

In fecal transplant, doctors transfer a processed fecal sample from a healthy person into the GI tract of someone who’s ill. The aim is to restore a healthy gut microbiome in the sick person by seeding it with beneficial bacteria.

C. difficile infections typically occur in people who’ve recently taken antibiotics, wiping out their natural gut bacteria.

C. difficile takes advantage of this situation and spreads rapidly in the colon, releasing toxins that cause watery and, eventually, bloody diarrhea, according to the Cleveland Clinic.

About 500,000 C. difficile infections occur in the U.S. each year, and 15,000 people die from it, the Cleveland Clinic says.

Currently, C. difficile is first treated with antibiotics like vancomycin, against which the bacteria has not developed a resistance. Fecal transplant only is employed to fight repeated infections, researchers said in background notes.

But because fecal transplant addresses the root cause of the infection, researchers suspected it might be effective as a front-line treatment for C. difficile.

For this clinical trial, researchers recruited 100 patients and randomly assigned about half for treatment with fecal transplant and the other half a course of vancomycin. The people were treated at 20 hospitals in Norway.

After 60 days, nearly 67% of the fecal transplant patients had been cured of their infection, compared with 61% of those who took antibiotics, results show.

“Our results indicate that it is reasonable to treat patients with primary C. difficile infection with FMT and provide antibiotics only to patients with ongoing symptoms or recurrence after FMT,” researchers concluded.

But more research is needed before fecal transplant can be widely adopted as a front-line treatment for C. difficile, according to an editorial by Dr. Elizabeth Hohmann, an infectious disease expert at  Massachusetts General Hospital in Boston.

“When should we use microbial products — at a first, second, or third episode of C. difficile infection? How long after antibacterial treatment should they be used? Does this vary by preparation?” Hohmann’s editorial asked. “Selecting the right patients for and timing of administration of gut microbial therapies is important.”

Her commentary offered a prediction.

“I do not believe that we in the United States will see FMT as a primary treatment of C. difficile infection anytime soon," she wrote. 

"But FMT should remain available” to patients, Hohmann added.

More information

Johns Hopkins Medicine has more on C. difficile infection.

SOURCE: Annals of Internal Medicine, June 16, 2025