Faecal transplant recommended by NICE for gut infection

NICE recommends that patients with recurrent bacterial infections are offered a faecal transplant to restore a healthy population of bacteria to the gut.

The treatment involves transplanting gut bacteria from a health donor’s poo into the gut of the recipient.

It is recommended that a faecal microbiota transplant (FMT) is only offered to people who have been treated for two or more Clostridium difficile (C. diff) infections without success.

What is Clostridium difficile or C.diff?

C.diff is a germ (bacterium) that causes an infection if the balance of bacteria in the bowel changes, which leads to diarrhoea and inflammation of the colon (colitis). Other symptoms include stomach tenderness or pain, loss of appetite, fever and nausea.

Certain groups are at higher risk of C.diff, including older people, those who have recently been an inpatient at a hospital or nursing home and those with a weakened immune system.

People who are taking antibiotics are seven to 10 times more likely to get C.diff infection for up to a month. This is because antibiotics can also get rid of the good germs that protect the body against harmful infections.

Types of faecal transplant

FMT can be performed in various ways, but it is usually done via colonoscopy. This allows the gastroenterologist to deposit a solution containing donor faeces directly into the colon.

The intestinal bacteria can also be delivered through a tube which is inserted into the nose, or it can be swallowed via a pill.

FMT could resolve up to 94% of C.diff infections

While FMT can lead to different levels of clinical cure depending on how the treatment is given, clinical evidence suggests it could resolve up to 94% of infections.

Modelling also shows that FMT is cheaper than treatment with almost all antibiotics, saving on average £769 compared with vancomycin taper pulse (VTP) if FMT is given using colonoscopy, and £8,297 if it’s given using an oral capsule.

FMT could therefore save the NHS thousands of pounds, lead to fewer antibiotics being used, and give patients a better quality of life.

FMT will also reduce the reliance on antibiotics

However, before the treatment is rolled out, NICE says a strict screening programme must be implemented to establish risk factors for transmissible diseases and factors influencing the gut microbiota.

Mark Chapman, interim director of Medical Technology at NICE, said the treatment will provide another tool for health professionals to use in the fight against this infection, while at the same time balancing the need to offer the best care with value for money.

“Use of this treatment will also help reduce the reliance on antibiotics and in turn reduce the chances of antimicrobial resistance, which supports NICE’s guidance on good antimicrobial stewardship,” he added.