Fecal bacteria as good as antibiotics for 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 cen- ter that has investigated socalled 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.

Several small clinical trials and doctors’ clinical experience have shown that a fecal transplant can help in that desperate situation.

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.

Instead, the research was intended to show that treatment with fecal bacteria is no worse.

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.

None of the antibiotic patients whose symptoms persisted after their first round of treatment were cured with a second round of the drugs.

Although the results seem to favor treatment with fecal bac- teria, the difference was not large enough to say fecal transplants were actually superior to the drugs. The researchers are planning to start a more definitive study with 200 patients this summer.

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, ranging from bowel diseases such as Crohn’s disease and ulcerative colitis

“to more far-fetched things, such as multiple sclerosis.”