Faecal transplants are recommended for all sorts of ailments these days. Indications recommended (not always by doctors!) include weight loss, inflammatory bowel disease and autism. The best evidence for faecal transplants, however, is in the treatment of C. difficile disease.C. difficile causes the most severe form of antibiotic associated diarrhoea. Courses of antibiotics kill off all the guts good bacteria leaving the C. difficile to multiply unopposed. Prophylactic probiotics have not been shown to reduce rates of C. difficile infections. Infections can occur during a course of antibiotics and even up to several months after. C. difficile infections are particularly associated with broad spectrum antibiotics. Appropriate diagnosis is important. Current treatment guidelines recommend repeat treatment with antibiotics in order to clear the gut of pathogenic organisms but this is not always successful and recurrence of the infection can occur.

Faecal transplants are currently considered last line treatment for C. difficile and the Therapeutic Guidelines recommend seeking expert advice. Alternatively (and concerningly), the internet provides Do-It-Yourself at Home instructions.

Although there are lots of claims about therapeutic effects from faecal transplants the evidence to support their use in other indications is limited. Even with the growing body of evidence for effectiveness against C. difficile infections few institutions are offering treatment due to regulatory concerns.

The microbiome presents a huge number of research opportunities. If successful, the trials currently underway around the world may provide us with a new treatment option for severe infections and chronic diseases which do not require additional antibiotics.

Picture credit: http://bioweb.uwlax.edu/bio203/s2009/kumm_jakl/