Fecal Microbiota Transplantation vs Medical Therapy for the Treatment of Clostridioides difficile Infection

Investigators assessed the efficacy of fecal microbiota transplantation vs medical therapy for the treatment of Clostridioides difficile infection.

Fecal microbiota transplantation (FMT) has demonstrated promise for the treatment of recurrent Clostridioides difficile infection (RCDI) but is not effective in every patient with CDI, according to a study published in the Journal of Clinical Gastroenterology.

The incidence and severity of CDI have increased tremendously in developed countries; treatment with FMT has gained popularity in the last decade. Researchers conducted a systematic review and meta-analysis to evaluate the effectiveness of FMT in the management of CDI compared with medical therapy (MT), consisting of standard antibiotic regimens.

The outcomes of interest were clinical cure, as confirmed by the resolution of diarrhea and/or negative CDI testing. The researchers defined primary CDI as the first episode of CDI confirmed endoscopically or by laboratory analysis, and RCDI as a laboratory or endoscopically confirmed episode of CDI after at least 1 course of antibiotics.

In total,  7 studies with 238 patients were included in the meta-analysis. FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session (P =.12) and multiple sessions of FMT (P =.07), compared with MT. Following subgroup analysis, FMT showed a statistically higher rate of response than MT for RCDI, but for primary CDI, there was no statistically significant difference between the 2 treatments.

This meta-analysis was limited by its small sample size and presence of heterogeneity. Additionally, the researchers noted the studies included in the analysis were not of high quality overall.

The researchers concluded, “FMT has shown very promising results for the treatment of RCDI, but it was not shown to be effective in every single patient with CDI especially patients with primary episode of CDI.” “At this moment of time, MT should continue to be the treatment of choice in patients with primary CDI,” they recommended.


Singh T, Bedi P, Bumrah K, et al. Fecal microbiota transplantation and medical therapy for Clostridium difficile infection meta-analysis of randomized controlled trials. J Clin Gastroenterol. Published online September 9, 2021. doi: 10.1097/MCG.0000000000001610