There are some medical treatments that sound perfectly reasonable when a doctor explains them. A fecal transplant is generally not one of them. The idea of transferring poop from a healthy person into the digestive tract of someone who is desperately ill has an undeniable “yuck factor.” But when the problem is a recurrent Clostridioides difficile (C. diff) [aka Clostridium difficile] infection, replacing a damaged intestinal ecosystem with healthy microbes can be remarkably effective.
C. diff often takes advantage of disruption caused by antibiotics. Instead of simply killing disease-causing bacteria, antibiotics can also wipe out many of the helpful organisms that normally inhabit the intestinal tract. That can leave an opening for C. diff to flourish, causing severe diarrhea, abdominal cramping, nausea and sometimes life-threatening complications.
If that sounds overly dramatic, here is a story that should get your attention.
When a C. Diff Infection Turned Deadly
“I had a friend who was prescribed clindamycin by her dentist for an infection in her gums. A few weeks later, she started having diarrhea and went to her doctor. She did not mention taking the clindamycin. He gave her a prescription which did not help. She called and was given a new prescription.
“After about two weeks, her husband took her to the emergency room. They life-flighted her to a larger hospital.
“Two months from the start of the diarrhea, she died.
“I feel the dentist should not have prescribed it because she had, in the past, had cancer and chemotherapy. I also feel the doctor should have asked if she had taken antibiotics or run tests. She was a wonderful person, very active in the community, and will be missed. This was an unnecessary death.”
How a Fecal Transplant Became Accepted Medical Practice
For years, doctors treating people with recurrent C. diff had to find carefully screened healthy stool donors and transfer processed fecal material, frequently during a colonoscopy. It sounded strange, but patients who had suffered through repeated rounds of antibiotics sometimes experienced dramatic recoveries.
One reader told us about such an experience more than a decade ago:
Q. My sister had a knee replacement in October and came home with a C. diff infection. Strong antibiotics were tried but nothing helped.
She was so sick that her children rushed her back to the hospital. Her doctor suggested a fecal transplant. That sounded disgusting, but it worked. Her daughter, my niece, was the donor. My sister went back to work this week! We are all delighted it was so effective.
A. Clostridium difficile (C. diff) is an intestinal infection that can cause debilitating or even life-threatening diarrhea. Antibiotics are not always effective.
A 2014 study found that fecal transplantation could cure hard-to-treat C. diff infections in 86 to 92 percent of cases (European Journal of Clinical Microbiology and Infectious Diseases, online March 14, 2014).
Fecal Transplant Has Come a Long Way
When we published that story in 2014, fecal microbiota transplantation still struck many people as an unconventional medical procedure. Since then, the science of the intestinal microbiome has exploded.
Researchers now recognize that the trillions of microorganisms living in the digestive tract form a complex community. Antibiotics can disrupt that community. In susceptible people, C. difficile can then gain the upper hand.
The goal of fecal microbiota transplantation is not simply to put someone else’s “poop” in the intestine. It is to restore a diverse community of beneficial microorganisms that can help keep C. diff under control.
In 2022, the FDA approved Rebyota, the first fecal microbiota product for preventing recurrent C. diff infection in adults after antibiotic treatment. It is administered rectally. In 2023, the agency approved Vowst, an oral product containing live fecal microbiota spores. Patients take four capsules daily for three days after completing antibacterial treatment.
That represents an extraordinary change. What once required finding an individual donor and arranging a fecal transplant can now, in appropriate patients, involve a standardized FDA-approved microbiota product.
The American Gastroenterological Association now incorporates this evidence into its guidelines. The 2024 guideline recommends fecal microbiota-based therapy for most adults with recurrent C. diff after they have completed standard antibiotic treatment.
Our latest reader’s experience shows why this approach has attracted so much attention:
Q. I developed C. diff as a result of taking the antibiotic ciprofloxacin. Even after treatment, the diarrhea would come right back. I read about fecal microbiota transplants because the C. diff was making me totally miserable.
My doctor has nurses on his staff on a special diet. One was the donor, with the poop checked beforehand to make sure it was safe.
The transfer took one hour, and I have never had a problem since. The good bacteria passed on to me did their job. I’m happy that this treatment was finally approved so people who need this procedure can benefit.
A. People who develop Clostridioides difficile (C. diff) infections often complain of severe cramping, nausea and dangerous diarrhea. Initially, gastroenterologists performing fecal microbiota transplantation had to find carefully screened donors with healthy stool. The fecal transplant was often performed via colonoscopy.
The FDA has now approved two microbiota products for adults with recurrent C. diff. Rebyota, administered rectally, was approved in 2022. Vowst, taken as capsules, followed in 2023. Neither is intended to replace antibiotics for an active C. diff infection. Instead, they are used after antibiotic treatment to help prevent the infection from coming back.
Final Words
Fecal microbiota therapy has traveled an extraordinary path. What once sounded like a desperate, unconventional treatment is now supported by years of research, professional guidelines and FDA-approved products. The terminology and techniques may have changed, but the goal remains the same: restore a healthier community of intestinal microbes so C. diff has a harder time taking over again.
For people trapped in a cycle of antibiotics, improvement and relapse, a fecal transplant or one of the newer microbiota therapies can offer something especially valuable: a chance to break that cycle. Anyone struggling with recurrent C. diff should ask a gastroenterologist whether one of these approaches might be appropriate.
Have you experienced recurrent C. diff or a fecal transplant? Please share your story in the comment section below.
