Fecal microbiota transplant is recommended on completion of standard-of-care antibiotics to prevent recurrence for adults with recurrent Clostridioides difficile (C. difficile) infection, according to a clinical practice guideline issued by the American Gastroenterological Association (AGA) and published in the March issue of Gastroenterology.

On behalf of the AGA, Anne F. Peery, M.D., from the University of North Carolina at Chapel Hill, and colleagues developed guidelines to provide recommendations on use of fecal microbiota-based therapies in adults with recurrent C. difficile infection, severe to fulminant C. difficile infection, inflammatory bowel diseases, including pouchitis, and irritable bowel syndrome. The Evidence-to-Decision framework was used to develop recommendations and provide considerations for implementation in clinical practice.

The guideline panel developed seven recommendations. The AGA suggests select use of fecal microbiota-based therapies upon completion of standard-of-care antibiotics to prevent recurrence among immunocompetent adults with recurrent C. difficile. Use of conventional fecal microbiota transplant is suggested in mildly or moderately immunocompromised adults with recurrent C. difficile infection. The AGA suggests against use of any fecal microbiota-based therapies to prevent recurrent C. difficile in severely immunocompromised adults. Select use of conventional fecal microbiota transplant is suggested for adults hospitalized with severe or fulminant C. difficile not responding to standard-of-care antibiotics. Except in the context of clinical trials, the AGA suggests against use of conventional microbiota transplant as treatment for inflammatory bowel diseases or irritable bowel syndrome.

“Fecal microbiota transplant is a safe and effective treatment with enough scientific evidence to be offered to most patients with two or more C. diff recurrences,” Peery said in a statement.

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