How to Apply FMT More Effectively, Conveniently and Flexible - A Comparison of FMT Methods

Purpose Metronidazol and vancomycin were long the two best options against Clostridioides (formerly Clostridium) difficile infections (CDI). Now, the cost of new drugs such as fidaxomicin directs us towards alternative treatment options, such as faecal microbiota transplant (FMT). Its effectiveness is similar to fidaxomicin. There are questions regarding its safety, but the biggest challenges are prejudice and inconvenience. Most protocols refer to FMT applied in the form of a solution. We investigated different modalities of FMT. Methods Instead of using nasoenteric tubes or colonoscopy, we place frozen or lyophilised stool in non-coated, size 00, hard gelatine capsules or enterosolvent, size 0 capsules. Results We found that non-coated, size 00, hard gelatine capsules are appropriate for conducting FMT. Capsules containing lyophilised supernatant with a low number of bacteria have been proven to be non-inferior to other FMT modalities. The primary cure rate in the supernatant group was 93.75%, and 66.67% in the sediment group. The overall cure rate was 82.14%. Depending on the protocol, 4-7 capsules are sufficient per patient. Capsules can be stored for up to one year at -20 degrees C. Conclusions FMT is a feasible alternative to antibiotic treatments in CDI. Our method makes the process flexible and less inconvenient to patients. Long storage time allows a consistent supply of capsules, while small volume and formulation make the procedure tolerable.

Automated summary

Fecal microbiota transplant (FMT) is an alternative treatment option for Clostridioides difficile infections (CDI), with effectiveness similar to fidaxomicin. This study found that non-coated, size 00, hard gelatine capsules are suitable for conducting FMT, and capsules containing lyophilised supernatant with a low number of bacteria are non-inferior to other FMT modalities.