Until now, the transplantation of healthy faecal bacteria into a patient's gut to tackle Clostridium difficile infections could only be done one of three ways: with an enema; a colonoscopy (placing a tube in the colon); or via a tube snaked through the nose and down the throat. But Canadian scientists have created capsules containing a concentrate of faecal bacteria that can simply be swallowed by the patient.
"It's much more palatable for patients," said Dr Tom Moore, a clinical professor of medicine at the University of Kansas, who was not involved with the study. "It takes a lot of the 'ick factor' out."
Even better, the capsules stopped recurring bouts of C. difficile, the Canadian researchers discovered. They plan to report their findings at IDWeek 2013, the infectious diseases society conference in San Francisco.
Cure desperately needed
A reliable cure for C. difficile is much needed. A recent article in the South African Medical Journal reported that, although the incidence of C. difficile is lower in South Africa than in the west, it still poses a big problem.
C. difficile itself is not antibiotic-resistant, but it gains a foothold in the gut when healthy intestinal flora are decimated by strong antibiotics used to overcome the resistance of other bacteria.
Once active, C. difficile causes severe diarrhoea in already weakened patients. About 250 000 people in the United States suffer from C. difficile infections every year and about 14 000 die, according to the CDC. Reliable statistics are not available for South Africa.
100% success rate
Doctors crafted the capsules by running healthy stool through a sieve, and then using a centrifuge to separate out the faecal bacteria and "discard everything but the bug", said study author Dr Thomas Louie, a professor of medicine at the University of Calgary, in Alberta.
The remaining faecal bacteria resembles off-white river clay, Louie said. It is scooped into a gelatine capsule, which is then placed inside two other layers of gelatine capsule to ensure that the bacteria will make it through the stomach to reach the lower intestine and the colon.
The researchers provided the pills to 27 patients with C. difficile and reported a 100% success rate. None of the patients had a recurrence of the infection, even though all of them previously had had repeat bouts with the germ. Patients ingested between 24 and 34 capsules containing faecal bacteria, often donated by family members.
Moore compared fighting C. difficile with faecal bacteria to restoring a lawn that has become infested with weeds.
It might be unusual, but poo now comes in a pill form to treat gut infection
C. difficile can be destroyed using antibiotics, much like using herbicides to get rid of the weeds, but that does nothing to restore the "lawn" within the gut to proper balance.
Alternatively, one can choose to reseed the lawn with fresh grass seed and hope the new grass crowds out the weeds. In the case of C. difficile, probiotics can sometimes boost healthy intestinal flora that crowd out the bad bug, Moore explained.
Faecal transplantation is more akin to planting fresh sod across the entire lawn, he suggested.
"This study confirms what has been suspected for quite some time, that faecal transplants are the most effective and most efficient way to restore gut health in patients with recurrent C. difficile," Moore said.
Further, he believes using capsules will make the process much easier for people.
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