Dung Defeats Drugs

Fecal transplants outcompeted traditional antibiotics at curing a deadly intestinal infection.

By Beth Marie Mole | January 18, 2013

PUBLIC DOMAIN, LADYOFHATSInfusing a healthy person’s stool into the intestines of another—a treatment known as a fecal transplant—successfully cured 15 out of 16 patients (94 percent) suffering from a recurrent and dangerous diarrheal infection of Clostridium difficile, according to clinical trial results published this week (January 16) in the New England Journal of Medicine. In contrast, traditional treatment with the antibiotic vancomycin only cured 7 out of 26 patients (27 percent). Though the success of the transplants convinced researchers to end the trial early, many physicians expected the results since fecal transplants have been used to treat hundreds of patients before, yielding a 90 percent success rate.

“Those of us who’ve been doing this procedure for some time didn’t need any more convincing, but the larger medical community needs to go through these steps,” gastroenterologist Alexander Khoruts, of the University of Minnesota in Minneapolis, who was not involved in the trial, told Nature. “It’s an unusual situation where we have more than 50 years of worldwide experience and more than 500 published cases, and only this far along does a randomized trial appear.”

The reason for the delayed trials and reluctant community, Khoruts and others say, is due to squeamishness by doctors and patients about the procedure, which aims to restore a healthy population of gut microbes in a sick person’s intestines. In particular, this latest infused healthy fecal material into a patient’s small intestine through a tube inserted in the patient’s nose. Though the study authors claim the nasal route is quicker and easier than the more common enema method, some doctors fear that patients will find the option repulsive. Researchers have even developed synthetic stool in hopes that it will increase patient acceptance.

Nevertheless, the authors say patients suffering from C. difficile infections are anxious to try the transplant. “We get e-mails from everywhere, from desperate patients asking to come to the hospital to get this treatment,” Els van Nood, an internal medicine researcher at the University of Amsterdam and a co-author of the study, told Nature. “They can still find a lot of reluctance [among doctors], and we hope that this will change.”

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