Donor Everything

Oh dear, we’re heading “down there” – again.

If you follow me on twitter, you may have seen that I tweeted about this last night after I saw it via a doctor friend on Facebook. Well, because my lab flooded overnight and I have no time to do anything at all today, it is going to serve as today’s blog post, especially for those that… er… didn’t see it last night.

From the New England Journal of Medicine, I give you: Donor Poo!

We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.

Putting that into English for you, they found some patients with diarrhoea and split them into three groups. The first lot got antibiotics, the second lot got antibiotics and a bowel wash and the ever-so-lucky third lot got antibiotics, a bowel wash and then some “healthy” poo squirted into their bowels via a tube in their nose.

Yes. You read that last bit correctly. But why would you do that?

Infusion of feces from healthy donors has been reported as an effective treatment for recurrent C. difficile infection in more than 300 patients.

Indeed, because it assists in restoring the “good bacteria” in the gut. So why isn’t this done more often?

Experience with this procedure is limited by a lack of randomized trials supporting its efficacy and the unappealing nature of the treatment.

No sh… er… no kidding.

And here’s how it was done:

Feces were collected by the donor on the day of infusion and immediately transported to the hospital. Feces were diluted with 500 ml of sterile saline (0.9%). This solution was stirred, and the supernatant strained and poured in a sterile bottle. Within 6 hours after collection of feces by the donor, the solution was infused through a nasoduodenal tube (2 to 3 minutes per 50 ml). The tube was removed 30 minutes after the infusion, and patients were monitored for 2 hours.

#OverlyHonestMethods, right there. Seriously, what twisted individual thought that up?
Far, far more than I needed to know. Or maybe just enough for you to try it at home. Which I am clearly advising you not to do.

But hey – here’s the really important bit – it worked!

Overall, donor feces cured 15 of 16 patients (94%). Resolution of infection occurred in 4 of 13 patients (31%) in the vancomycin-alone group and in 3 of 13 patients (23%) in the group receiving vancomycin with bowel lavage.

Isn’t science brilliant?

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