Fecal Microbiota Transplantation by Freeze-Dried Oral Capsules for Recurrent Clostridium difficile Infection

To the Editor—Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (CDI) [1]. However, the methods of administration used most frequently—colonoscopy, nasoduodenal infusion, and enema—are inconvenient for patients and healthcare facilities. Thus, recent demonstrations that FMT can be administered via oral capsules and as a frozen preparation have been important advances [2–5]. Louie et al [4] formulated fresh stool suspensions from related donors into oral capsules and Youngster et al [5] capsulized frozen suspensions from unrelated donors, both with success rates of 90% or higher with 1 or 2 treatments. We postulated that freeze-dried fecal material delivered via oral capsules would provide similar efficacy while providing greater stability and palatability. Beginning in February 2015, we incorporated this method of preparation into the FMT programs at MetroHealth Medical Center and the Cleveland Veterans Affairs Medical Center. Subsequently, another center has reported successful treatment of 1 patient by FMT with freeze-dried capsules [6]. Here, we report our experience testing viability of freeze-dried fecal material and treating 20 patients with recurrent CDI by FMT via freeze-dried oral capsules. The Institutional Review Boards of the Cleveland VA Medical Center and MetroHealth Medical Center deemed the study to be exempt from review because it was a case series describing routine patient management.