The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

Faecal microbiota transplant (FMT) involves the transfer of a sample of faeces from a healthy donor to a recipient. There are several different ways to administer the transplant, including via endoscopy, rectally as an enema, via nasogastric/nasoenteral tube (tube passed through the nose into the stomach/upper part of the small intestine), or via oral ingestion of capsules that contain faecal material. The transplant may either be administered fresh (i.e. immediately after preparation), or may be prepared in advance, stored in a freezer and thawed when required. FMT is an accepted and effective treatment for recurrent infection by Clostridium difficile, a bacterium which can cause severe illness with diarrhoea, most commonly in frail elderly populations as a complication of antibiotic use. Despite adequate treatment, Clostridium difficile infection recurs in about 25% of patients, and some may suffer multiple recurrences.

This guideline reviews the evidence for FMT as a treatment for Clostridium difficile infection (CDI) and other conditions. Recommendations are made for: which patients are most likely to benefit, how donors should be selected and screened, how FMT should be prepared and administered, how patients should be followed up, and how FMT services should be configured.