II. Indications

  1. Three or more recurrent episodes of
  2. C. difficile cases severe and refractory to Vancomycin or Fidaxomicin

III. Medications: Fecal Transplant Source

  1. Healthy donor (e.g. spouse or stool bank) with normal fecal flora
    1. Stool bank sources typically cost $1700 per dose
    2. Donors are screened for infectious disease (e.g. HIV Infection)
  2. Rebyota
    1. FDA approved product, $9000 per dose on release in 2023
    2. Contains fecal microbiota from pooled sources screened for infectious disease
    3. Introduced via rectal enema
  3. Vowst
    1. FDA approved for preventing C. difficile recurrence, $17,500 for a 3 day course in 2023
    2. Taken orally by patient at home (without Nasogastric Tube)
    3. Contains only spores and does not require refrigeration

IV. Technique

  1. General (all preparations)
    1. C. difficile antibiotics should be completed at least 2 to 4 days prior to dose
    2. Avoid systemic antibiotics for at least 8 weeks after dose
  2. Donor transplants
    1. Single dose sample typically introduced via Nasogastric Tube or similar
    2. Small volume fecal amount (25 grams) sufficient to reestablish normal flora
  3. Vowst
    1. Laxative (choose one) taken 1 day prior to starting 3 day course
      1. Magnesium Citrate 10 oz (included in Vowst kit) OR
      2. Polyethylene Glycol Solution 250 ml

V. Efficacy

  1. Long term cure rates approach 92% in some studies
  2. Resolution without recurrence in 25% of patients at 2 months with Vowst

VII. References

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