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The recent editorial entitled “ Microbiota replacement for Clostridium difficile by capsule is as effective as via colonoscopy ” by Saha & Khanna provides an excellent review of the clinical efficacy, as well as the delivery options, for fecal microbiota transplantation (FMT) for patients suffering from a recurrent, C. difficile infection (rCDI) (1). The review also highlights the uncertainty that is relating to the optimal dose, or the delivery route for FMT (1). Admittedly, FMT is a crude and archaic method, with many drawbacks despite the high efficacy and lack of short term safety concerns. The long-term consequences remain to be determined, as the potentials for transferring infectious agents, or donor traits such as obesity, exist.

The need to move away from fecal transplant towards targeted, refined microbiome therapy