Borgia Guglielmo, Maraolo Alberto Enrico, Foggia Maria, Buonomo Antonio Riccardo, Gentile Ivan
University of Naples "Federico II", Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Naples , Italy +39(0)81 7463178 ; +39(0)81 7463190 ;
Expert Opin Biol Ther. 2015 Jul;15(7):1001-14. doi: 10.1517/14712598.2015.1045872.
INTRODUCTION: Clostridium difficile infection (CDI) is a leading cause of diarrhea in the industrialized world. The estimated costs of this infection are impressive: over 3.2 billion dollars annually in the US. The introduction of fecal microbiota transplantation (FMT) to clinical practice can be considered a Copernican Revolution. The rationale of this approach consists of correcting the imbalance of the organisms dwelling in the gut by reintroducing a normal flora. AREAS COVERED: This review focuses on the indication for FMT in CDI; it examines in-depth the most relevant aspects of the techniques used, and the safety and efficacy of this new 'old' therapy. EXPERT OPINION: Authoritative guidelines about the management of CDI strongly recommend FMT for multiple recurrent episodes of infection by C. difficile unresponsive to repeated antibiotic treatment. The cure rates are about 90%, with no serious adverse events having been reported. The main concerns are the long-term outcomes, lack of a standardized procedure for the delivery of donor material, and a cultural barrier to the transplantation of fecal microbiota. A promising solution to some of these problems could be the use of a more acceptable administration route of fecal material, namely, oral capsules.
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