Clostridium difficile is a life-threatening bowel infection that old people in particular are liable to contract when in hospital (indeed, the rate of such hospital-acquired infection is one indication of the general state of hygiene of hospitals). The infection gives rise to dangerous diarrhea and can be very difficult to treat. The usual method is therapy with an antibiotic, vancomycin, together (sometimes) with bowel washout; but in a sixth to a quarter of cases there is a recurrence. In addition, vancomycin is a drug with serious side-effects.
The authors, from Holland, divided patients with recurrent Clostridia into three groups: those who received vancomycin for fourteen days, those who received it for fourteen days plus bowel washout, and those who received vancomycin for four days and then a duodenal infusion of a solution of donor feces, the donors of the latter having first been screened for various communicable diseases of course.
Originally the authors had expected to enroll 40 patients in each group to show a difference between them, but as the trial progressed the results were so clear-cut (as is rarely the case in such trials) that it became unethical to continue. The cure rate of those given the infusion of feces 81 percent, or 94 percent on repeat treatment; in the other groups it was 31 percent in the vancomycin alone group and 23 percent with vancomycin plus bowel washout. Furthermore, 83 percent of the patients who did not respond to antibiotics were cured by infusion of feces.
Recolonization of the bowel by normal bacteria, then, is better than antibiotic therapy alone. Here is a case in which rationality must overcome revulsion. My admiration is great for the person who first thought of such a therapy: imagination leapt over prejudice. If it had been up to me, I should have waited passively until the pharmaceutical industry developed a more effective antibiotic than vancomycin. With this method, however, the raw material is abundant and cheap and not, I presume, under patent.
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