Last reviewed: December 2018
Last updated: September  2018
25 Sep 2018

UK guidance recommends faecal microbiota transplant for recurrent of refractory C difficile infection

Updated guidelines on the management of Clostridium difficile infection (CDI), with a focus on the use of faecal microbiota transplant, have been published by the British Society of Gastroenterology and Healthcare Infection Society.

The guidelines support the use of faecal microbiota transplant (FMT) as a second-line treatment option in patients with recurrent or refractory CDI, after considering first-line options including antimicrobial therapy and/or antitoxin therapy.

For recurrent infection, the guidelines recommend FMT in patients who have had at least 2 recurrences, or patients with one recurrence and risk factors for further episodes (e.g., severe/complicated infection). FMT should used with caution in immunosuppressed patients.

These recommendations support US guidelines published earlier in the year by the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America.

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • diarrhoea
  • abdominal pain

Other diagnostic factors

  • fever
  • abdominal tenderness
  • nausea and vomiting
  • abdominal distension
  • symptoms of shock

Risk factors

  • antibiotic exposure
  • advanced age
  • hospitalisation or residence in a nursing home
  • history of Clostridium difficile-associated disease
  • use of acid-suppressing drugs
  • inflammatory bowel disease
  • solid organ transplant recipients
  • haematopoietic stem cell transplant recipients
  • chronic kidney disease
  • HIV infection
  • immunosuppressive agents or chemotherapy
  • gastro-intestinal surgery

Diagnostic investigations

1st investigations to order

  • FBC
  • stool guaiac (faecal occult blood test)
  • stool PCR
  • stool immunoassay for glutamate dehydrogenase
  • stool immunoassay for toxins A and B
  • abdominal x-ray
Full details

Investigations to consider

  • cell culture cytotoxicity neutralisation assay
  • CT abdomen
  • sigmoidoscopy or colonoscopy
Full details

Emerging tests

  • stool lactoferrin or calprotectin
Full details

Treatment algorithm


Authors VIEW ALL

Clinical Associate Professor of Medicine

Alabama Infectious Diseases Center




AH declares that he has no competing interests.

Peer reviewers VIEW ALL

Department of Epidemiology

Division of General Medicine and Epidemiology

UNC at Chapel Hill

Chapel Hill



JA declares that he has no competing interests.

Consultant Gastroenterologist

Department of Gastroenterology

John Radcliffe Hospital




SK declares that he has no competing interests.

Clinical Reader and Consultant Gastroenterologist

Norfolk and Norwich University Hospital




IB declares that he has no competing interests.

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