'Poo transplants' work better than antibiotics (we wish we were joking)

While there’s no doubt antibiotics have changed the world and improved health outcomes for millions of people, they have their limitations, including increasingly resistant pathogens and the way they wipe out “good bacteria” in the gut.

Now, scientists and doctors alike are looking to a new solution – and, while it’s not pretty, it shows great promise.

Gut microbes play a key role in our immune systems and health, and transplanting faecal matter from one person to another is increasingly being used to control severe life-threatening infections like recurrent Clostridium difficile that kill thousands of people annually, report the British Medical Journal.

The procedure involves introducing a liquidised stool (or frozen microbes) from a healthy donor to the bowel of a patient to re-colonise their gut with healthy bacteria, which are often destroyed after prolonged antibiotic treatment.

An analysis of the evidence found an 85 per cent success rate with faecal transplants compared with only 20 per cent success for standard antibiotic treatment. And a recent trial was stopped early because of the overwhelming superiority of faecal transplantation, with 90 per cent success rate compared with 26 per cent for powerful antibiotics.

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So far, after over 7000 transplants, few adverse effects are being reported, and despite early fears, transplants even seem relatively safe in elderly patients or those with an impaired immune system, say Professor Tim Spector from King’s College London and Professor Rob Knight from the University of California San Diego.

The procedure is increasingly popular in the US, and the use of faecal transplantation for C difficile infection has now been cautiously endorsed by the American Academy of Gastroenterology and European Society of Microbiology and Infectious Diseases.

While European and Australian regulators are stalling, the UK regulator (MRHA) has temporarily classed faecal transplants as a medicinal product (with exemptions from many of the usual regulatory barriers).

However, experts say the treatment needs careful monitoring and should not be seen as a “cure-all”.

While “it is clearly better than further antibiotics for treating conditions like C difficile”, the use of faecal transplantation is being increasingly tested in other common conditions, including obesity, diabetes, irritable bowel syndrome, colitis and many others. However, claims that faecal transplantation could be a cure-all for many diseases, “are probably too optimistic,” say Spector and Knight.

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As well as the obvious risks of infection (reduced by screening), there are longer term potential risks of transferring microbes to a new host, which could include transferring susceptibility to obesity and even mental illness, they write. “These possible risks suggest that faecal transplantation, although an exciting new tool, should be carefully monitored and refined to include most of the key beneficial microbes.”

“We urgently need more expertise and centres, proper screening of donors, and good long term trials and monitoring procedures in order to provide sensible advice,” they conclude. Otherwise, patients with many chronic complaints “may lose patience and take matters into their own hands (using DIY methods) with unpredictable consequences.”

Tell us, would you be okay with this treatment if it became mainstream and passed all the regulatory hoops, or is the “ick factor” just too much to bear?