OpenBiome Webinar

On March 28th 2023, we hosted a live webinar featuring an expert panel of physicians from Boston Children's Hospital, Texas Children's Hospital, and the University of Minnesota. The panel discussed special considerations for caring for pediatric patients with C. difficile including diagnosis and treatment with investigational fecal microbiota transplantation (FMT).

Key takeaways and an FAQ are shared below.

Key Takeaways

Pediatric Investigational FMT referrals should be carefully evaluated for possible alternate diagnoses.
Up to about 25% of cases may be explained by alternative diagnoses, the most frequent being constipation leading to overflow diarrhea in a concomitantly C. difficile colonized patient, unrecognized ulcerative colitis, Crohn's disease, abdominal migraine, and milk protein allergy.
For pediatric patients with C. difficile and potential IBD, the panel recommended delivering investigational FMT by colonoscopy to check for inflammation.
If active inflammation is found while the patient is on antibiotics, the investigational FMT should be delayed. IBD should be optimally managed (i.e., using suppressive vancomycin) before using investigational FMT to treat C. difficile to increase treatment efficacy and to minimize the risk of inducing a flare.
Further studies on the efficacy of colonoscopic delivery are needed especially in pediatric populations.
In addition, AGA's FMT National Registry tracks and collects investigational FMT procedure data and is a critical resource for understanding short and long-term safety and efficacy. OpenBiome strongly encourages enrollment in the AGA's FMT National Registry.

Frequently Asked Questions

Before stool banks were founded, investigational FMT donors were originally selected from healthy family members or close friends. This directed-donor model led to delays in treatment, high costs, and safety risks as patients and physicians found it difficult to screen for healthy donors. These barriers to care were reduced by stool banks, which spread the cost of screening donors across multiple stool donations, and centralized manufacturing so that investigational FMT treatments can be delivered overnight.

The panel recommended sourcing investigational FMT material from a stool bank that rigorously screens doors for infectious pathogens as well as potential non-communicable diseases (such as obesity) that may be mediated through the microbiome.

There may be benefits to age-matching but doing so is logistically difficult. The panel agreed that using adult donor stool for investigational FMT recipients above three years of age is a promising treatment option for recurrent C. difficile.

When infusing new microbes into a patient via investigational FMT, doctors should maximize engraftment by taking the patient off antibiotics in advance of the investigational FMT. A common practice is stopping antibiotics on the day of the bowel prep before colonoscopic delivery and two days before capsule delivery. (Note: Additional research and clinical trials are needed to identify the optimal timing for halting antibiotic use.)

A healthy diet encompassing various sources of fiber and reducing unprocessed food generally improves microbiome health and recovery but there is no standard protocol for dietary changes or probiotic usage.