FMT may be used as first-line therapy for primary CDI

A recent study in Norway has recommended the use of faecal microbiota transplantation (FMT) as a first-line treatment to patients with primary Clostridioides difficile infection (CDI).

Some 104 adults with CDI and previous CDI within 365 days prior to enrolment were randomized to receive either FMT without antibiotic pretreatment or oral vancomycin 125 mg four times daily for 10 days. Of these, 100 patients were eligible for analysis.

The primary endpoints of clinical cure (firm stools or <3 bowel movements daily) and no disease recurrence within 60 days without additional treatment was achieved by 34 of 51 patients in the FMT group and 30 of 49 in the vancomycin group (66.7 percent vs 61.2 percent; difference, 5.4 percentage points, 95.2 percent confidence interval [CI], –13.5 to 24.4; p<0.001 for noninferiority).

Additional C. difficile treatment was administered to 11 patients in the FMT group and four in the vancomycin group.

Furthermore, 40 of 51 patients on FMT and 30 of 49 on vancomycin achieved clinical cure at day 14 and no recurrence with or without additional treatment (78.4 percent vs 61.2 percent; difference, 17.2 percentage points, 95.2 percent CI, –0.7 to 35.1).

Adverse events did not significantly differ between the two treatment arms.

This multicentre, noninferiority, randomized trial was limited by its open-label design and reliance on clinical endpoints.