Faecal microbiota transplantation for primary Clostridioides difficile infection

Faecal microbiota transplantation (FMT) is recommended for recurrent Clostridioides difficile (C. difficile) infection. The recommended treatment for primary C. difficile infection is antibiotics. We present a patient who requested FMT for primary C. difficile infection.

A patient in her sixties developed primary C. difficile infection following antibiotic therapy atter surgery for small bowel volvulus. The patient refused antibiotic treatment and contacted a research group that had just concluded a randomised phase III trial assessing FMT for primary C. difficile infection. The trial had not yet been published, and FMT was not included in guideline recommendations for this indication. After joint decision-making involving the patient, her general practitioner, gastroenterologists and the research group, the patient received FMT and experienced complete remission of C. difficile symptoms within two days of treatment.

This case illustrates how to evaluate experimental versus established treatments in light of new evidence and patient preferences that do not align with guideline recommendations.