Fecal bacteria, not antibiotics, cured patients with deadly infection

The bacteria can take over a person’s intestines and be difficult to eradicate. The infection causes fever, vomiting, cramps and diarrhea so severe that it kills 14,000 people a year in the United States alone.

The first line of treatment for the attacking microbes, called Clostridium difficile, is antibiotics. But a group of Norwegian researchers

asked if something more unusual — an enema containing a stew of bacteria from feces of healthy people — might work just as well.

The answer, according to a new report in the New England Journal of Medicine, is yes.

Until now, there has never been a clinical trial conducted in more than one medical center that has investigated so-called fecal transplants as a first therapy for C. difficile infections,

said Dr. Michael Bretthauer, a gastroenterologist at the University of Oslo and lead author of the new study.

The Food and Drug Administration permits fecal transplants, and professional societies endorse them, but only as a last resort for treating C. difficile infections after antibiotics have failed, said Dr. Alexander Khoruts, a gastroenterologist at the University of Minnesota.

“It’s definitely a paradigm

shift to use it earlier rather than later,” Dr. Nasia Safdar, an infectious-disease specialist at the University of Wisconsin, Madison.

The study, conducted in Norway, was small — just 20 patients randomly assigned to get the fecal bacteria or antibiotics. That’s not enough to determine whether transplants are better than antibiotics. The researchers are planning to start a more definitive study

with 200 patients this summer.

Five out of nine patients who received fecal bacteria were cured immediately of their infections, compared with five of 11 in the group getting antibiotics. Three of the four remaining patients who got fecal bacteria then got antibiotics; two were cured within days.

The idea behind fecal transplants is to provide a dose of healthy gut bacteria that multiply and crowd out

the dangerous germs making patients ill. The bacteria can be extracted from feces and supplied as an enema or in a capsule that patients swallow.

Researchers are exploring the use of fecal transplants for a variety of conditions, Bretthauer said.

“Using feces is a little taboo,” Bretthauer said. “If you are putting someone else’s feces into a patient, there has to be a good reason.”