Hundreds of patients struggling to ward off superbugs are to be treated with poo transplants on the NHS using gut bacteria taken from healthy donors’ faeces.
The National Institute for Health and Care Excellence (Nice), the health regulator, has given the green light for a faecal microbiota transplant (FMT) to be offered to people who have been treated for two or more Clostridium difficile (C diff) infections without success.
The revolutionary treatment aims to restore a healthy population of gut bacteria in sick patients by transferring a batch of different gut bacteria and other microorganisms from healthy donor poo into the gut of the recipient.
C diff is a type of bacteria that can cause diarrhoea, and often affects people who have been taking antibiotics. People are more likely to get a C diff infection if they are over 65, have been staying in hospital or a care home for a long time, or if they have a weakened immune system – for example, from having a long-term condition such as diabetes or kidney failure, or treatments including chemotherapy.
It can usually be treated with a different type of antibiotic but is referred to as a superbug due to its resistance to treatment in some instances.
Nice said clinical trials showed that FMT treatments are significantly better than antibiotics alone at resolving a stubborn C diff infection.
The health regulator said it had been presented with evidence that the treatment could save the NHS thousands of pounds. It may also mean patients could take fewer antibiotics and experience a better quality of life after treatment, it added.
The new bacteria can be delivered through a tube inserted directly into the stomach through the nose, or alternatively be deposited directly into the colon through a tube or swallowed via a pill.
Mark Chapman, interim director of medical technology at Nice, said: “There is currently a need for an effective treatment of C diff in people who have had two or more rounds of antibiotics.
“Our committee’s recommendation of this innovative treatment will provide another tool for health professionals to use in the fight against this infection, while at the same time balancing the need to offer the best care with value for money.
“Use of this treatment will also help reduce the reliance on antibiotics and in turn reduce the chances of antimicrobial resistance, which supports Nice’s guidance on good antimicrobial stewardship.”
Nice said it made its decision after reviewing evidence from five trials of 274 adults.
The data showed that more C diff infections were resolved with FMT than antibiotic treatment in four of the trials and there was no difference in the other. FMT can lead to different levels of clinical cure depending on how the treatment is given but it could resolve up to 94% of infections, Nice said.
Modelling shows that poo transplants are cheaper than treatment with almost all antibiotics. They save the NHS about £769 if given using a colonoscopy, and as much as £8,297 if administered using an oral capsule. It costs £1,287 per patient more if given as an enema. But FMT via enema would only be an option for the minority who cannot have FMT by another route, Nice said.
Nice estimates that 450 to 500 people in England could be treated using FMT for multiple recurrences of C diff infections each year.
It said that a strict donor screening programme should be in place and that treatments should be manufactured in accordance with human medicine regulations.
