Faecal Transplant – Appearantly A Very Good Clostridium Difficile Treatment

Ed Yong:

Last week, I wrote about scientists who developed a stool substitute and used it to cure gut infections in two women. This sham poo contained 33 gut bacteria, which were meant to displace the harmful ones that were causing diarrhoea in the patients.

… [Now] the first results from a [larger] faecal transplant trial [to treat Clostridium difficile] have been published in the New England Journal of Medicine, and they are a resounding vindication for the technique.

The infusions of faeces cured 94 percent of patients who received it (15 out of 16), all of whom had already suffered at least one relapse of C.difficile. By comparison, the standard antibiotic—vancomycin—only cured 27 percent of patients (7 out of 26). The difference was so great that the Dutch team behind the study had to stop the trial early. Everyone eventually received the faecal transplants.

The technique had no negative side effects except for the rare bout of constipation, and diarrhoea for a few hours after the infusions. That’s nothing compared to the gastrointestinal agony of a bout with C.difficile.

I’ve written about the trial for Nature News, so head over there for the details. For now, I’ll highlight a couple of points from the trial. …

This ties in nicely with what David Healy said: drugs that "really" work show their effects in small trials.

Faecal Transplant is still in its infancy, but I'm sure there are a few more diseases were a faecal transplant might at least prove helpful.

[Update] From the Nature News article:

“Those of us who’ve been doing this procedure for some time didn’t need any more convincing, but the large medical community needs to go through these steps,” says Alexander Khoruts, a gastroenterologist at the University of Minnesota in Minneapolis, who was not involved in the trial. “It’s an unusual situation where we have more than 50 years of worldwide experience and more than 500 published cases, and only this far along does a randomized trial appear.”

O.o

There is something definitely wrong in the land of evidence based medicine. Clearly there is no alternative to the scientific method (I shudder to think of those "alternative/integrative/traditional/holositic/whatever" quacks who believe in things that don't even pass the hurdle of evidence-based-medicine) – but there seem to be so many places where medicine is stuck, for decades it seems. While I'm sure that evidence-based-medicine beats the alternative quacks, one can at the same time not trust evidence-based-medicine to now what works, or what doesn't.