Traditional Fecal Transplant Outperforms New Oral Therapy in Severe C. difficile Cases

A recent study conducted by researchers at the UNC School of Medicine has revealed that, in cases of severe Clostridioides difficile (C. diff.) infections, traditional fecal microbiota transplants via colonoscopy remain more effective at preventing severe recurrence compared to the newer oral therapy using fecal microbiota spores. Published in Clinical Gastroenterology & Hepatology, this research highlights important differences in long-term outcomes between these two treatment modalities.

The study was prompted by the increasing adoption of fecal microbiota spores, an FDA-approved non-invasive pill designed to prevent recurrent C. diff. infection. While the therapy gained popularity due to its convenience, researchers at UNC identified a concerning trend: patients treated with spores experienced a higher incidence of severe disease, including fulminant C. diff. infections, upon recurrence.

C. diff. infections often occur after antibiotic use, which disrupts the gut’s natural balance and allows harmful bacteria to thrive. With around 500,000 American cases annually, effective prevention strategies are critical. Traditional fecal microbiota transplants, performed via colonoscopy, have been used for over a decade to restore healthy gut bacteria, although they are still classified as investigational by the FDA.

The new oral spores therapy, approved in 2023, involves taking capsules three times daily post-antibiotics to prevent infection recurrence. UNC began implementing this treatment after approval but lacked direct comparative data on patient outcomes against the established colonoscopy method.

In their comparison of adult patients treated at UNC, the researchers found both therapies effectively prevented recurrence overall. However, among the small subset of patients who did experience a recurrence, those who received spores were more prone to developing fulminant disease, including sepsis. Specifically, 2 out of 28 patients receiving spores were admitted with severe infection, while no such cases occurred among 102 patients treated with colonoscopic fecal transplants.

Dr. Sarah McGill emphasized the importance of vigilant post-treatment monitoring regardless of therapy type. The findings suggest that while microbial spores are suitable for outpatient, less severely ill patients, traditional fecal transplants may be preferable for critically ill or hospitalized patients, particularly in severe cases.

This study underscores the necessity for healthcare providers to carefully select treatment strategies based on patient condition and to remain cautious of potential severe recurrences associated with newer therapies. As regulatory agencies and medical centers continue to evaluate available options, these insights will aid in optimizing care for patients with recurrent C. diff. infections.

Source: https://medicalxpress.com/news/2025-06-traditional-fecal-transplant-outperforms-pill.html