II. Indications
- Three or more recurrent episodes of
- C. difficile cases severe and refractory to Vancomycin or Fidaxomicin
III. Medications: Fecal Transplant Source
- Healthy donor (e.g. spouse or stool bank) with normal fecal flora
- Stool bank sources typically cost $1700 per dose
- Donors are screened for infectious disease (e.g. HIV Infection)
- Rebyota
- FDA approved product, $9000 per dose on release in 2023
- Contains fecal microbiota from pooled sources screened for infectious disease
- Introduced via rectal enema
- Vowst
- FDA approved for preventing C. difficile recurrence, $17,500 for a 3 day course in 2023
- Taken orally by patient at home (without Nasogastric Tube)
- Contains only spores and does not require refrigeration
IV. Technique
-
General (all preparations)
- C. difficile antibiotics should be completed at least 2 to 4 days prior to dose
- Avoid systemic antibiotics for at least 8 weeks after dose
- Donor transplants
- Single dose sample typically introduced via Nasogastric Tube or similar
- Small volume fecal amount (25 grams) sufficient to reestablish normal flora
- Vowst
- Laxative (choose one) taken 1 day prior to starting 3 day course
- Magnesium Citrate 10 oz (included in Vowst kit) OR
- Polyethylene Glycol Solution 250 ml
- Laxative (choose one) taken 1 day prior to starting 3 day course
V. Efficacy
- Long term cure rates approach 92% in some studies
- Resolution without recurrence in 25% of patients at 2 months with Vowst
VI. Resources
VII. References
- (2023) Presc Lett 30(3): 16
- (2023) Presc Lett 30(8): 44
- Gough (2011) Clin Infect Dis 53(10): 994-1002 [PubMed]
- Brandt (2012) Am J Gastroenterol 107(7): 1079-87 [PubMed]