Fresh and frozen stool are equally effective
A randomized, double-blind noninferiority trial compared the effectiveness of frozen and thawed FMT with that of fresh FMT in 219 patients ≥18 years of age with recurrent or refractory CDIs.3 Researchers prescribed suppressive antibiotics, which were discontinued within 24 to 48 hours of FMT, and then administered 50 mL of either fresh or frozen stool by enema. They repeated the FMT with the same donor stool if symptoms didn’t improve within 4 days. Any patient still unresponsive was offered repeat FMT or antibiotic therapy.
Researchers defined a 15% difference in outcome as a clinically important effect. Intention-to-treat analysis yielded no significant difference in clinical resolution between groups (75% frozen vs 70.3% fresh; P=.01 for noninferiority).
Nasogastric delivery works as well as colonoscopy
An open-label RCT (not included in the reviews described previously) evaluated the effectiveness of colonoscopically administered FMT compared with that of nasogastric administration in 20 patients with recurrent or refractory CDIs.4 Patients had experienced either a minimum of 3 episodes of mild-to-moderate CDI with a failed 6- to 8-week taper of vancomycin or 2 episodes of severe CDI resulting in hospitalization. Researchers offered patients from both groups a second FMT if symptoms didn’t improve with the initial administration.
Eight patients in the colonoscopy group and 6 in the nasogastric group were cured (all symptoms resolved) after the first FMT. One patient in the nasogastric group refused subsequent administration. All 5 remaining participants chose to have subsequent nasogastric administration (80% cure rate). Both methods of administering FMT produced comparable cure rates (80% in the initial nasogastric group vs 100% in the initial colonoscopy group; P=.53).
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