Hundreds of people with difficult-to-treat superbugs are being offered fecal transplants to deal with their infections.
In a fecal microbiota transplant (FMT), healthy bacteria are transferred “in a mixture of prepared processed stool from a healthy donor” to another person’s gut.
The National Institute for Health and Care Excellence (Nice) says the trial should be considered for patients who have undergone two or more treatments for Clostridium difficile (C.diff) unsuccessfully.
Treating these people with gut bacteria from a healthy person’s poop can help restore healthy gut bacteria, Nice said.
C.diff is a type of bacteria that can cause diarrhea, and it often affects people who have taken antibiotics.
The bug can usually be treated with another type of antibiotic, but is sometimes referred to as a “superbug” because of the resistance to treatment in some cases.
Nice said clinical trials have shown that FMT treatment is significantly better than antibiotics alone at clearing a stubborn C.diff infection, and treatment with this method could save the NHS thousands of pounds.
Patients may need to take fewer antibiotics and have reported a better quality of life after treatment, it added.
The FMT section can be swallowed in a pill, or it can be administered through a tube that is inserted directly into the stomach through the nose, or alternatively, it can be deposited directly into the colon, also through a tube.
Mark Chapman, interim director of medical technology at Nice, said: “There is currently a need for effective treatment of C.diff in people who have had two or more courses of antibiotics.
“Our committee’s recommendation for this innovative treatment will provide health professionals with another tool to use in the fight against this infection, while also balancing the need to provide the best care with value for money.
“Using this treatment will also help reduce antibiotic dependence and in turn reduce the likelihood of antimicrobial resistance, supporting NICE’s guidelines for good antimicrobial stewardship.”
Nice said it made the decision to continue with FMT after considering evidence from five studies involving 274 adults, which showed that more C.diff infections were resolved with FMT, than antibiotic treatment, in four of the studies – and there was no difference in the other.
The data also showed that the treatment can resolve up to 94% of infections.
FMT can be significantly cheaper than antibiotics when given as an oral capsule – a saving of over £8,000; it can save hundreds of pounds when given as a colonoscopy, but is more expensive when given as an enema.
Nice estimates that 450 to 500 people in England could be treated with FMT annually for multiple recurrences of C.diff infections.
It said there must be a strict donor screening program and treatments must be manufactured in accordance with human medicine regulations.
All donors will be pre-screened to ensure that the stool provided is healthy and tested for a wide range of viral, bacterial and parasitic infections, including screening for COVID-19.