FMT with no prior antibiotics

If you have had or are considering an FMT please share your experiences here.
CorinneD
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FMT with no prior antibiotics

Postby CorinneD » Fri Jun 17, 2022 7:18 am

Hello everyone,

I am a 42-year female and I live in France. I have a rare form of refractory celiac disease - meaning, the disease does not respond to the gluten-free diet, but the manifestations are atypical (healed villi, but other types of lesions and weird cells in the small bowel, I'll spare you more technical details; add to that severe intolerance to most foods). Cortico-steroids usually given for refractory celiac don't really work. What works to keep my symptoms at bay is a very restrictive diet, i.e. for the past two years I have been eating exclusively beef, since this is the only food I tolerate, and have taken small amounts of vitamins (it's very difficult to find supplements and medications I tolerate). I have not been on any medication apart from vitamins since 2020.

In February of this year, following a routine control, I was diagnosed with a c. diff. infection, meaning the toxins A and B were negative, but they detected the genes for the toxins in my stool (which was normal, not watery, at the time of the test). (N.B. I hadn't taken antibiotics in 10 years. I suspect I was colonised by c. diff. during a 2020 colonoscopy when I was on steroids too.) Now, for a number of months I had been having sporadic watery diarrhea, 3-5 times/day - which was a new symptom for me. It was not triggered by me ingesting any food I do not tolerate, nor any medication or supplement, and would resolve on its own in max. a week. Due to these symptoms and the positive toxin genes, I was put on a trial course of oral vancomycin (the IV version, that I took orally, 125 mg 4 times/day).

This triggered watery diarrhea from the very first dose, which became shortly fairly severe (10+ stools/day with occasional incontinence). My doctor advised that I should plod on, which I did, despite the inherent difficulties. When I finished the course, the diarrhea did not go away. It gradually diminished to 3-5 watery stools/day, but it's taken me about 3 months to begin to feel a little better. In the meantime - first stool test after vancomycin: toxins positive, not only the genes. (I am suspecting I have a strain resistant to vancomycin - when I took the antibiotic, it killed c. diff's competition and this helped activate it properly. My doctor claims it is not possible for c. diff. to be resistant to vancomycin.) At any rate, I was put on fidaxomicin (Dificlir, same as Dificid) - no effect on my symptoms, good or bad, I kept having diarrhea, 3-5 times/day. Stool tests after fixadomicin: toxins positive.

The next step is that I should do an FMT. The protocol requires me to be on 500 mg vancomycin 4 times/day (that's 4 times more than the initial posology) until 48 hours before the procedure. Seeing my previous reaction to vancomycin, I am not willing to take it again. However, my doctor insists that no FMT can be performed without antibiotics and that fidaxomicin will not do for this purpose.

Could you please let me know if anyone has had FMT done without taking any antibiotics right before the procedure and if it has worked?

Many thanks in advance.

GtrGrl
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Re: FMT with no prior antibiotics

Postby GtrGrl » Fri Jun 17, 2022 6:48 pm

I took vanco beforehand, as have others on here. My understanding is that they have to kill as much C Diff as possible but also your own bacteria, to clear the way for the new healthy ones. I like Roy’s analogy of it being like seeding a new lawn. As fidaxomicin only kills C Diff, perhaps that’s why they don’t use it for this purpose.

I hope you can go ahead and that the FMT helps you.
Contracted C Diff from a round of Flucloxacillin, November 2020.

Metronidazole - Metronidazole - Dificid - Dificid - Vancomycin - Upper GI FMT - Vancomycin - Vancomycin - Lower GI FMT

beth22
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Joined: Tue Apr 07, 2009 2:23 pm

Re: FMT with no prior antibiotics

Postby beth22 » Fri Jun 17, 2022 8:20 pm

I have had more than one FMT and I NEVER took that much vancomycin. I was told you need to take it for 4 days before and just regular dose. I also know people who have taken Dificid before and it was no problem. There is also a protocol to do the initial FMT with taking the meds before and then for 4 or 5 days after the FMT to do stool enemas. Those are done without any meds. There are various methods and protocols.

CorinneD
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Posts: 12
Joined: Fri Jun 17, 2022 6:35 am

Re: FMT with no prior antibiotics

Postby CorinneD » Fri Oct 14, 2022 6:44 am

I eventually did an FMT at a different hospital, by enema and with no prior antibiotics, since they had either no effect or made me worse. The FMT still worked, it is now two weeks later and I have been having mostly formed, solid stools for the past week.

Of note, there were no laxatives before the FMT either. They had a very weird protocol that only required a minimum of 100 days on a low-residue diet. I qualified since I've been eating only beef for a lot longer than that. Not being comfortable with the lack of a colon prep, I decided on my own to fast in preparation. I did not eat for 24 hours, then had no water either for the following 6 hours until the procedure. I kept the donor stool in for 6.5 hours and during this time I still didn't eat so as not to trigger peristalsis, I only drank some water. Needless to say, I am very happy that it worked despite not following what seems to be the standard protocol.


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