Fecal Transplantation for C difficile: A How-To Guide
Who is a candidate for FMT, and how do you get started?
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The AGA set some fairly strong guidelines about candidates for FMT. Appropriate candidates are patients who have relapsing CDI (a history of 3 or more episodes, or 2 episodes that required hospitalization), or patients with refractory disease that is unresponsive to traditional antibiotics.
We are now seeing patients who present with toxic megacolon as a result of CDI. This may be an emerging role for treatment with FMT.
There is also emerging evidence for its use in inflammatory bowel disease; some of these patients have been successfully treated with FMT.
At present, however, I would restrict the use of FMT to the treatment of CDI, for which we have the best evidence.
The donor needs to undergo an evaluation.
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The US Food and Drug Administration has guidelines for donors of human cells, tissues, and cellular and tissue-based products. The AGA guidelines suggest using the American Association of Blood Banks Donor History Questionnaire to screen potential donors.
The donor must be screened for transmissible bloodborne diseases, such as hepatitis, HIV-1 and HIV-2, and syphilis. Donors are not eligible if they have taken antibiotics within the last 3 months, because this can change the intestinal microflora and present some transmission risk to the recipient. Other disease states that may be associated with microflora changes include irritable bowel syndrome and constipation, so the donor should also be screened for these conditions. In addition, I screen potential recipients for a history of food allergies. The donor should not ingest foods to which the recipient is allergic within 5 days before the donation.
The stools have to be screened also, which should involve an evaluation for transmissible pathogens (such as giardia) and other infectious enteric pathogens.
The AGA recommendations include a specific list of what patients and donors should be screened for. The cost of doing these tests is about $500 and may not be covered by insurance. Clinicians must therefore determine how the screening costs will be covered.
Patient Selection Guidelines
Who is a candidate for FMT, and how do you get started?
[ CLOSE WINDOW ]
(Enlarge Slide)
The AGA set some fairly strong guidelines about candidates for FMT. Appropriate candidates are patients who have relapsing CDI (a history of 3 or more episodes, or 2 episodes that required hospitalization), or patients with refractory disease that is unresponsive to traditional antibiotics.
We are now seeing patients who present with toxic megacolon as a result of CDI. This may be an emerging role for treatment with FMT.
There is also emerging evidence for its use in inflammatory bowel disease; some of these patients have been successfully treated with FMT.
At present, however, I would restrict the use of FMT to the treatment of CDI, for which we have the best evidence.
Donor Selection Guidelines
The donor needs to undergo an evaluation.
[ CLOSE WINDOW ]
(Enlarge Slide)
The US Food and Drug Administration has guidelines for donors of human cells, tissues, and cellular and tissue-based products. The AGA guidelines suggest using the American Association of Blood Banks Donor History Questionnaire to screen potential donors.
The donor must be screened for transmissible bloodborne diseases, such as hepatitis, HIV-1 and HIV-2, and syphilis. Donors are not eligible if they have taken antibiotics within the last 3 months, because this can change the intestinal microflora and present some transmission risk to the recipient. Other disease states that may be associated with microflora changes include irritable bowel syndrome and constipation, so the donor should also be screened for these conditions. In addition, I screen potential recipients for a history of food allergies. The donor should not ingest foods to which the recipient is allergic within 5 days before the donation.
The stools have to be screened also, which should involve an evaluation for transmissible pathogens (such as giardia) and other infectious enteric pathogens.
The AGA recommendations include a specific list of what patients and donors should be screened for. The cost of doing these tests is about $500 and may not be covered by insurance. Clinicians must therefore determine how the screening costs will be covered.
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