Is FMT only a last-resort option?

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Elvish2
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Is FMT only a last-resort option?

Postby Elvish2 » Fri Feb 07, 2020 2:56 pm

Hi all,
I'm on day 6 of a 10-day course of Dificid (set to do a taper/pulse when the original 10 days are finished), with my symptoms much calmed down but still not "back to normal" (unsurprisingly - at least I'm not passing m. 15+ times a day any more!). I'm waiting to hear back from a GI referral - I had a choice between an Infectious Disease or a GI doctor, and my PCP told me that if I was interested in talking about FMT, the GI is the only one that can do that. So I opted for a GI doctor, thinking that I'd at least have that option to discuss if it came to it.

But as I'm waiting to hear back about that appointment, it got me thinking - are FMTs only done when all else fails? If the GI brings up doing one as I finish up Dificid to help repopulate my gut, is that something that's "done"? (ETA: Or have I not tried enough other options yet to consider FMT?)
I'm wondering about this since I had thought that nine years after my first bout with c-diff in 2011 (successfully treated with a Flagyl taper/pulse), my gut would've healed enough on its own to not be thrown back into full-on c-diff after the five doses [ETA: to clarify, five pills into one 10-day prescription] of Augmentin that set off this one, but apparently not...
Last edited by Elvish2 on Fri Feb 07, 2020 9:27 pm, edited 3 times in total.
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.

jG43
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Re: Is FMT only a last-resort option?

Postby jG43 » Fri Feb 07, 2020 3:42 pm

I had a fmt a year ago after relapsing on a Vanco taper. Part of my problem was that I was initially given flagyl then Vanco by a pcp. I was also given a choice of referral between a GI and ID. My GI had me finish a Vanco taper and pulse that my pcp had started. By starting with Dificid you probably have a much better chance of avoiding relapse. My GI told me that the medical protocol is to go to fmt after 2 to 3 relapses. I was put in a 10 day course of Dificid then 2 days later had a fmt via colonoscopy. I recovered fairly quickly after the fmt. Both my pharmacist and GI had cdiff around 7 to 10 years ago but recovered with 10 days of flagyl. My pharmacist, who I really trust, said that cdiff has become much more resistant and tougher to get rid of in the last few years. My GI said the relapse rates for flagyl and vancomycin continue to increase and flagyl is no longer a recommended treatment. My GI who is the cdiff specialist in my area said that he continues to see an increase of cdiff in younger patients who are not around hospital environments. He feels that the cdiff bacteria is evolving so that it is harder to treat with antibiotics. Unfortunately in my GI’s opinion it seems that fmt is the only option besides dificid that has a high success rate and low rate of relapse. I am a healthy male in my early 40s and I have rarely used antibiotics over my life. Probably less than 6 or 7 times in my adult life. But I was prescribed 7 days of Clindamycin for a hand injury that required some stitches and got a
Cdiff infection 3 weeks after my last dose of it. I relapsed after 10 days of flagyl then 10 days of Vanco then an 8 week Vanco taper. At that point my GI was adamant that I do 10 days of Dificid and fmt. I was uneasy about it but I am glad I did. After that much antibiotic he said the relapse chances would just get higher and higher from the good bacteria that had been wiped out. I used a donor from open biome which is a lab in Massachusetts that was started by doctors who had a colleague who could not get over cdiff. They provide safe specimens to hospitals in the US and other countries.

Hope the taper works but a least know that fmt is another option with a high success rate if you can’t get healthy with the Dificid

Elvish2
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Re: Is FMT only a last-resort option?

Postby Elvish2 » Fri Feb 07, 2020 5:11 pm

Thanks for sharing your detailed experience, jG43 - lots of insight! Sounds like it may be another week or two at least before I can get the GI appointment, so I just want to be prepared as possible for what to discuss when I actually do get in, wherever I end up being recovery-wise.
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.

D1dad
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Re: Is FMT only a last-resort option?

Postby D1dad » Fri Feb 07, 2020 5:45 pm

You relapsed after 5 pills of augmentin or 5 prescriptions?

Elvish2
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Re: Is FMT only a last-resort option?

Postby Elvish2 » Fri Feb 07, 2020 9:27 pm

D1dad: after 5 pills - 2.5 days into one 10-day prescription. I guess it would be a "recurrence" rather than a relapse since my last instance of c-diff was in 2011.
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.

D1dad
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Re: Is FMT only a last-resort option?

Postby D1dad » Sat Feb 08, 2020 9:45 am

Wow I’m sorry to hear that and it’s very concerning considering augmentin caused my nightmare. Over the past 8 yrs have you taken any other antibiotics? I always told my doc anytime he wanted to prescribe augmentin it made me feel awful and the last time it got me.

Elvish2
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Re: Is FMT only a last-resort option?

Postby Elvish2 » Sun Feb 09, 2020 1:44 am

This was (to the best of my recollection) the first time I'd taken antibiotics since 2011!
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.

beth22
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Re: Is FMT only a last-resort option?

Postby beth22 » Sun Feb 09, 2020 3:20 am

FMT is not a guarantee that you won't get another recurrence if you take an antibiotic again. I have had more than one FMT for that very reason. I took Cipro for another infection and got an even worse case of c difficile than my first rounds with it. In 2016 I was hospitalized with complications from the flu and had not had a positive test in years, but about a month after taking the antibiotics, I tested positive again and stayed that way for over two years. However, after the first few days I did not have D any longer, so I did not need to treat. So, even if you do an FMT, you will still have to be really careful about future antibiotic use.

Elvish2
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Re: Is FMT only a last-resort option?

Postby Elvish2 » Wed Feb 12, 2020 4:22 pm

Thanks, beth22 - good to note that FMT is not a "cure all" and won't mean one can just take antibiotics with no worries in the future.

I have a GI appointment later today (there was a cancellation that they gave me), so we'll see how it goes! Hoping I get a doctor who's knowledgeable about c-diff and treatment. I'm doing pretty well having just finished a 10-day course of Dificid, and starting a taper today.
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.

D1dad
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Re: Is FMT only a last-resort option?

Postby D1dad » Fri Feb 14, 2020 10:52 am

How’s things going? Your case has really hit home and I couldn’t imagine. At some point we all take antibiotics and one would think after 8 yrs you would have recovered your gut health enough to withstand it. I know personally, unless it’s life or death, I’ll never take augmentin again. I made my doc specifically note in (my chart) what augmentin caused. He didn’t like it but I don’t care. I spend most of my work days in hospitals and nursing homes, my daughter is an RN and there’s no doubt I’m exposed to cdiff on a regular basis.

Elvish2
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Re: Is FMT only a last-resort option?

Postby Elvish2 » Sat Feb 29, 2020 1:29 pm

Hi D1dad, thanks for checking in! I'm on the tail end of a Dificid taper/pulse and doing pretty well. The GI doctor I saw seemed pretty good overall and approved my taper/pulse schedule.

That's a good idea about having my doctor note specifically in my chart what Augmentin/antibiotics have done in the past! I felt like I mentioned my past history with c-diff a number of times to my doctor, including bringing up concerns when she prescribed the Augmentin, but having it noted down may make it carry more weight.
2011: contracted c-diff after taking Amoxicillin and Cipro. Successfully treated with Flagyl taper. (Posts under old username, Elvish)

2020: contracted c-diff after taking Augmentin. Finished Dificid taper/pulse on 3/15.


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