Oral FMT capsules safe, effective for recurrent C. difficile infection

Oral faecal microbiota transplantation (FMT) capsules for recurrent Clostridioides difficile infection (rCDI) appear more favourable than FMT through colonoscopy because of ease of administration and its noninvasive delivery, a study has shown.

“FMT through colonoscopy is established as effective and safe in treating multiple recurrences of CDI, but consensus has not been established on delivery through oral capsules,” the authors said.

To address this, they performed a systematic literature search of multiple databases such as Medline and Embase to identify original studies with at least 10 patients that assessed the role of oral FMT capsules to treat rCDI.

Random effects model was used to pool cure rates and the Egger test to assess publication bias. The authors also performed secondary analyses to examine the differences between capsule preparation (frozen vs lyophilized stool) and delivery modality (capsule vs colonoscopy).

Fifteen studies (12 case series and three randomized controlled trials) including a total of 763 patients met the eligibility criteria. There was a significant variability observed in baseline patient characteristics and protocols.

In a meta-analysis of proportions, the efficacy of oral FMT capsules was 0.821 (95 percent confidence interval, 0.762–0.874). Evidence for publication bias was not found (p=0.51). In secondary analyses, there were no significant differences seen in terms of efficacy.

Fourteen adverse events leading to death or hospitalization were reported. However, none of these were related to FMT.

“We found an overall efficacy of 82.1 percent with a low rate of serious adverse events,” the authors said. “Further studies are needed to optimize protocols and outcomes.”