SCIENCE
10/14/2014 08:37 am ET

Poop Pills May Offer A Better Way To Eradicate This Deadly Infection

courtesy Hohmann Lab

A promising new study puts a decidedly positive spin on the epithet "eat sh**."

It shows that pills containing human fecal matter are an effective treatment for people suffering from potentially deadly infections caused by the bacterium known as Clostridium difficile.

The pills may be a more palatable alternative to existing methods of administering so-called fecal microbiota transplants (FMT), a.k.a. fecal bacteriotherapy--a treatment proven to curb the severe diarrhea and other symptoms that characterize C. diff infections.

"Numerous reports have shown that FMT is effective in treating active C. difficile infection and preventing recurrences in patients whose infections failed to respond to standard treatments," Dr. Ilan Youngster, a fellow in pediatric infectious diseases at Massachusetts General Hospital and one of the scientists involved in the study, said in a written statement released by the hospital. "The procedures that have been used before--colonoscopies, nasogastric tubes, even enemas--all have potential risks and discomforts for patients."

As Dr. Elizabeth Hohmann, a staff physician at Mass General and another of the researchers, told NPR, "Just getting the tube down is a problem." And doctors worry that if people gag and vomit, they could inhale fecal matter.

"That's pretty scary," she said.

Conducted at Mass General, the study involved 20 patients between 11 and 84 years of age, all of whom had persistent or recurrent C. diff infections. On two consecutive days, each patient swallowed acid-resistant capsules containing fecal material that had been collected from carefully screened stool donors and then filtered, diluted, and frozen before being encapsulated. Patients whose symptoms didn't improve within 72 hours were offered a second course of treatment.

What happened? Symptoms resolved completely with a single treatment in 14 of the patients, with no recurrence during the following eight weeks. Five of the six remaining patients got a second treatment about one week later, and symptoms resolved in five of them, with one experiencing a recurrence. Symptoms persisted in one patient even after a second course of treatment.

Those results translate into a 90-percent success rate, according to the researchers.

C. diff infections cause about 250,000 hospitalizations and 14,000 deaths in the U.S. each year, according to the statement. They're commonly spread in hospitals when patients come into contact with bed linens, bed rails, bathroom fixtures, and other things that have been contaminated with the germs.

In addition to watery diarrhea, symptoms include fever, nausea, loss of appetite, and belly pain. Treatment with antibiotics can make matters worse, because the drugs kill off beneficial bacteria in the intestinal tract along with the C. diff bacteria.

FMT is believed to work by restoring a healthy balance of microbes. But rather than having a doctor administer the treatment, some people resort to a do-it-yourself version of FMT, in which an enema is used to transfer fecal material collected from friends or family members--a practice doctors consider risky.

"Many people can be carriers of bacteria, viruses, and parasites that are shed in their stools but have no symptoms," Youngster said in the statement. "It's not enough to know your donor and just ask how he or she feels, as some websites suggest. In any form, this procedure should only be performed under strict medical supervision with material from thoroughly screened donors."

A report describing the research was published online on Oct. 11 in the Journal of the American Medical Association.

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