People receiving antibiotic medications in health care settings are often at a higher risk of contracting infections, with the most common ones being from the bacterium Clostridium difficile, a potentially life-threatening bacteria. Now, in a preliminary study, researchers have successfully cured patients of recurrent C. difficile infections (CDIs) by treating them orally with frozen fecal matter contained in capsules. Published in the Journal of the American Medical Association, the study found that the treatment stopped incidences of diarrhea 90 percent of the time.

While a majority of us carry C.difficile bacteria in our guts, people taking antibiotics are still vulnerable to a CDI. That’s because in normal guts, populations of other bacteria keep C.difficile in check. However, once antibiotics destroy these other bacteria, C. difficile proliferates, unchecked. Because of this, CDIs kill 14,000 adult and pediatric patients each year in the U.S. In most cases, the cause of death is severe diarrhea or acute inflammation of the bowel.

If the spores C. difficile releases are able to exit an infected person's guts, and travel through the air to another person, the cycle can start again. Treating these infections becomes more difficult when the bacteria have become resistant to certain antibiotics, such as metronidazole or vancomycin.

Researchers have found that fecal microbiota transplantation (FMT), or stool transplants, could be efffective in managing or curing CDI. It involves introducing fecal bacteria from a healthy individual to the gut of a sick patient. Certain issues, however, such as methods to introduce the bacteria and the long-term impact of the treatment, have led to difficulty getting the treatment implemented.

To get around this problem, doctors started using frozen fecal matter from healthy donors, and transplanted them into patients via a nasogastric tube. This technique was found to be just as effective as a fresh stool transplant. The doctors then took this innovation further and placed the fecal bacteria into a capsule that would be consumed orally, thus eliminating the need for gastrointestinal procedures.

The researchers used these frozen capsules on 20 patients with recurrent CDI. Each patient took 15 capsules on two consecutive days, and were then tracked for six months. Fourteen of the 20 patients (70 percent) had clinical resolution of diarrhea after the first administration of capsules, and remained symptom-free at eight weeks. All six non-responders were treated again at about seven days after the first procedure. Four of them obtained responded to the treatment, which meant the capsules were 90 percent effective.

Bowel movements gradually improved as well, with patients experiencing a median of five the day before they took the capsules to two on the third day and one at eight weeks. Patients also reported improving overall health, and there were no adverse reactions to taking the capsules.

"If reproduced in future studies with active controls, these results may help make FMT accessible to a wider population of patients, in addition to potentially making the procedure safer," the researchers wrote, according to a press release. "The use of frozen inocula allows for screening of donors in advance. Furthermore, storage of frozen material allows retesting of donors for possible incubating viral infections prior to administration. The use of capsules obviates the need for invasive procedures for administration, further increasing the safety of FMT by avoiding procedure-associated complications and significantly reducing cost."

Source: Youngster I, et.al, Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection, JAMA, 2014.