A potentially deadly and virulent bug that attacks the gut may soon be treated with the most stomach-churning of remedies.
A study published on Thursday in the New England Journal of Medicine has found transplanting human faeces into people with the superbug Clostridium difficile provided an almost universal cure for the condition – far outperforming traditional antibiotic treatment.
Faecal microbiota transplantation is thought to work by replacing the healthy bacteria in the gut that have been wiped out by antibiotics. For the past 20 years an Australian, Thomas Borody, has pioneered the treatment, although its use has been traced back thousands of years.
"This study is monumental," Professor Borody said.
The research found nearly 94 per cent of patients given the transplantation one or two times recovered, compared to only 30 per cent of the group given the antibiotic vancomycin. The study was then stopped early by an ethics committee on the ground that it would be unethical not to offer all patients the transplants.
Professor Borody said C. difficile, which has ravaged the US, killing 30,000 people each year, was spreading to Australia, although no one could be sure how common it was as health departments did not routinely test for it.
"In Sydney we have had about 15 deaths that we know of . . . in the past year and a half," he said.
Just as people now donate blood and semen, in future donors may be called on to give stools.
At present the faeces is inserted into the recipient using colonoscopy or nasal tube but researchers are developing a less off-putting method.
"The future of this FMT is filtered bacteria, washed, frozen and put in a capsule, which we lovingly call a 'crapsule'," said Professor Borody, from the Centre for Digestive Diseases and the University of Technology, Sydney.
The clinical associate dean at the St George Hospital clinical school at the University of NSW, Michael Grimm, said trying to find appropriate donors could be difficult.
"We are just starting now to grapple with the bacteria in the gut; it's an impossible soup to analyse," Professor Grimm said. "What potential pathogens are in there that might not have been pathogenic to the host but could become pathogenic to the recipient, are really unknown."
He said the study also only followed patients for 10 weeks, so he would like to see more long-term data as he had patients who relapsed up to two years after being infected.
"But overall I think it's exciting," he said. "This infection is a disaster and it's becoming more and more common and more and more virulent."
The study author, Josbert Keller, from the Academic Medical Cent re in the Netherlands, said the results should convince more doctors to offer the transplants.
But he said there was some reluctance from doctors to offer it even though patients, in particular older people who had experienced recurrent infection, were asking for it.
"The potential transmission of infectious diseases will always be an issue. Therefore, very careful selection of donors is important. This is a major obstacle," Dr Keller said.
"Donor faeces infusion is non-appealing, and physicians are reluctant (of course), especially because they are not familiar with the procedure. However, if patients suffer from numerous relapses of C. difficile, there is no other treatment option available."