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Updated: Jun 12, 2026
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Fecal bacteriotherapy for relapsing Clostridium difficile infection in a child: a proposed treatment protocol
George Russell1, Jess Kaplan, Maryjane Ferraro
1Division of Gastroenterology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Insights
Fecal bacteriotherapy effectively treated relapsing Clostridium difficile infection (CDI) in a young child refractory to standard treatments. This approach offers a promising option for complicated pediatric CDI cases.
Area of Science:
- Microbiology
- Pediatric Gastroenterology
Background:
- Clostridium difficile infection (CDI) is an emerging infectious disease with increasing incidence in children.
- Relapsing CDI cases have risen significantly, posing a therapeutic challenge.
Observation:
- A 2-year-old child presented with relapsing CDI caused by the epidemic BI/NAP1/O27 strain.
- The infection was refractory to probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG) and multiple antibiotics (metronidazole, vancomycin, rifaximin, nitazoxanide).
Findings:
- Fecal bacteriotherapy administered via nasogastric tube was successful in treating the relapsing CDI.
- This marks the first demonstration of fecal transplantation's efficacy in a young child with refractory pediatric CDI.
Implications:
- Fecal transplantation is a practical and effective treatment for severe, relapsing pediatric CDI.
- This therapy should be considered for complicated pediatric CDI cases unresponsive to conventional treatments, pending further research.
Abstract:
Clostridium difficile infection (CDI) is a potentially serious emerging infectious disease. The incidences of CDI in childhood and CDI cases complicated by relapses have increased by 50% or more in North America during the past 2 decades. We report here the case of a 2-year-old child with relapsing CDI caused by the epidemic strain BI/NAP1/O27 that was refractory to Saccharomyces boulardii and Lactobacillus rhamnosus GG probiotics and to intensive therapy with traditional (metronidazole, vancomycin) and experimental (rifaximin, nitazoxanide) antibiotics despite its apparent antimicrobial-susceptible phenotype. After excluding other infectious causes of diarrhea and inflammatory bowel disease, we designed a protocol to safely administer fecal bacteriotherapy via a temporary nasogastric tube. We demonstrated for the first time that fecal transplantation is practical and effective for treating relapsing CDI in a young child. We recommend that this strategy be reserved for complicated cases of CDI that fail conventional therapy until randomized studies can confirm the safety and effectiveness of fecal bacteriotherapy in children.
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