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Where Stool is a Drug: International Approaches to Regulating the use of Fecal Microbiota for Transplantation

Published online by Cambridge University Press:  01 January 2021

Abstract

Regulatory agencies vary widely in their classification of FMT, with significant impact on patient access. This article conducts a global survey of national regulations and collates existing FMT classification statuses, ultimately suggesting that the human cell and tissue product designation best fits FMT's characteristics and that definitional objectives to that classification may be overcome.

Type
Symposium 1 Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2019

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References

Kelly, C. et al., “Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook,” Gastroenterology 149, no. 1 (2015): 223227.CrossRefGoogle Scholar
Rosner, J.L., “Ten Times More Microbial Cells than Body Cells in Humans?” Microbe Magazine 9, no. 2 (2014): 4747 at 47.CrossRefGoogle Scholar
Ma, Y., Chen, H., Lan, C., and Ren, J., “Help, Hope and Hype: Ethical Considerations of Human Microbiome Research and Applications,” Protein Cell 9, no. 5 (2018): 404415 at 404; M.E., “What Is the Human Microbiome, Exactly?” Nautilus, available at <http://nautil.us/blog/what-is-the-human-microbiome-exactly> (last visited July 26, 2019).CrossRefGoogle Scholar
Surawicz, C.M. et al., “Guidelines for Diagnosis, Treatment and Prevention of Clostridium difficile Infections,” The American Journal of Gastroenterology 108, no. 4 (2013): 478498 at 478.CrossRefGoogle Scholar
See Surawicz et al., supra note 4 at 478; Chang, J.Y. et al., “Decreased Diversity of the Fecal Microbiome in Recurrent Clostridium difficile –Associated Diarrhea,” The Journal of Infectious Diseases 197, no. 3 (2008): 435438 at 437.CrossRefGoogle Scholar
See Surawicz et al., supra note 4 at 486.Google Scholar
Kassam, Z., Lee, C.H., Yuan, Y., and Hunt, R.H., “Fecal Micro-biota Transplantation for Clostridium difficile Infection: Systematic Review and Meta-Analysis,” The American Journal of Gastroenterology 108, no. 4 (2013): 500508 at 505; Cammarota, G. et al., “Randomised Clinical Trial: Faecal Micro-biota Transplantation by Colonoscopy vs. Vancomycin for the Treatment of Recurrent Clostridium difficile Infection,” Alimentary Pharmacology and Therapeutics 41, no. 8 (2017): 835843 at 840.CrossRefGoogle Scholar
See Surawicz et al., supra note 4 at 478.Google Scholar
Desai, K. et al., “Epidemiological and Economic Burden of Clostridium Difficile in the United States: Estimates From A Modeling Approach,” BMC Infectious Diseases 16, no. 1 (2016): 110 at 1.Google Scholar
Centers for Disease Control and Prevention, “Antibiotic Resistance Threats in the United States,” (2013) at 51.Google Scholar
Lessa, F.C. et al., “Burden of Clostridium difficile Infection in the United States,” New England Journal of Medicine 372, no. 9 (2015): 825834 at 825.CrossRefGoogle Scholar
See Surawicz et al., supra note 4 at 486.Google Scholar
Maroo, S. and Lamont, J.T., “Recurrent Clostridium difficile,” Gastroenterology 130, no. 4 (2006): 13111316 at 1311.CrossRefGoogle Scholar
Olsen, M.A. et al., “Recurrent Clostridium difficile Infection is Associated with Increased Mortality,” Clinical Microbiology and Infection 21, no. 2 (2015): 164170 at 170.CrossRefGoogle Scholar
See Centers for Disease Control and Prevention, supra note 10 at 51.Google Scholar
Dancer, S.J., “The Role of Environmental Cleaning in the Control of Hospital-Acquired Infection,” Journal of Hospital Infection 73, no. 4 (2009): 378385 at 380-381.CrossRefGoogle Scholar
Pamer, E.G., “Resurrecting the Intestinal Microbiota to Combat Antibiotic-Resistant Pathogens,” Science 352, no. 6285 (2016): 535538 at 535.CrossRefGoogle Scholar
van Nood, E. et al., “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile,” New England Journal of Medicine 368, no 5 (2013): 407415 at 414.CrossRefGoogle Scholar
See Z. Kassam, C.H. Lee, Y. Yuan, and R.H. Hunt, supra note 7 at 505; see G. Cammarota et al., supra note 7 at 840.Google Scholar
Konijeti, G.G., Sauk, J., Shrime, M.G., Gupta, M., and Ananthakrishnan, A.N., “Cost-effectiveness of Competing Strategies for Management of Recurrent Clostridium difficile Infection: A Decision Analysis,” Clinical Infectious Diseases 58, no. 11 (2014): 15071514 at 1507.CrossRefGoogle Scholar
Lee, C.H. et al., “Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients with Recurrent Clostridium difficile Infection: A Randomized Clinical Trial,” Journal of the American Medical Association 315, no. 2 (2016): 142149 at 142.CrossRefGoogle Scholar
Wang, S. et al., “Systematic Review: Adverse Events of Fecal Microbiota Transplantation,” PLOS ONE 11, no. 8 (2016), available at <https://dx.plos.org/10.1371/journal.pone.0161174> (last visited April 15, 2019).Google Scholar
Collins, S.M., Kassam, Z., and Bercik, P., “The Adoptive Transfer of Behavioral Phenotype Via the Intestinal Microbiota: Experimental Evidence and Clinical Implications,” Current Opinion in Microbiology 16, no. 3 (2013): 240245 at 240.CrossRefGoogle Scholar
Khoruts, A. et al., “The Impact of Regulatory Policies on the Future of Fecal Microbiota Transplantation,” Journal of Law, Medicine & Ethics 47, no. 4 (2019): 482504.CrossRefGoogle Scholar
Edelstein, C.A., Kassam, Z., Daw, J., Smith, M.B, and Kelly, C.R., “The Regulation of Fecal Microbiota for Transplantation: An International Perspective for Policy and Public Health,” Clinical Research and Regulatory Affairs 32, no. 3 (2015): 101109 at 102.CrossRefGoogle Scholar
Lozupone, C.A., Stombaugh, J.I, Gordon, J. I, Jansson, J. K, and Knight, R., “Diversity, Stability and Resilience of the Human Gut Microbiota,” Nature 489, no. 7415 (2012): 220230.CrossRefGoogle Scholar
See C.A. Edelstein, Z. Kassam, J. Daw, M.B Smith, and C.R. Kelly, supra note 25 at 107.Google Scholar
Khoruts et al., supra note 24.Google Scholar
Eakin, E., “The Excrement Experiment,” The New Yorker, December 1, 2014, available at <https://www.newyorker.com/magazine/2014/12/01/excrement-experiment> (last visited April 17, 2019).Google Scholar
See Khoruts et al., supra note 24.Google Scholar
Smith, M.B., Kelly, C., and Alm, E.J., “Policy: How to Regulate Faecal Transplants,” Nature News 506, no. 7488 (2014): 290291.CrossRefGoogle Scholar
21 § CFR 1271.3 (2001).Google Scholar
Megerlin, F., Fouassier, E.,Lopert, R., and Bourlioux, P., “Faecal Microbiota Transplantation: A Sui Generis Biological Drug, Not a Tissue,” Annales Pharmaceutiques Françaises 72, no. 4 (2014): 217220.CrossRefGoogle Scholar
Therapeutic Goods Administration, Options for the Regulation of Faecal Microbiota Transplantation Material (January 2019).Google Scholar
Professor Thomas Borody, The Centre for Digestive Diseases, available at <https://centrefordigestivediseases.com/about-us/professor-thomas-borody/> (last accessed April 30, 2019).+(last+accessed+April+30,+2019).>Google Scholar
Email communication between the author and P. Stadelmann of Swissmedic (April 8, 2019).Google Scholar
Roldan, G.A., Cui, A.X., and N.R, “Assessing the Burden of Clostridium difficile Infection in Low- and Middle-Income Countries,” Journal of Clinical Microbiology 56, no. 3 (2018): e0174717; Burke, K.E. and Lamont, J.T, “Clostridium difficile Infection: A Worldwide Disease,” Gut Liver 8, no. 1 (2014): 16.CrossRefGoogle Scholar
Center for Biologics Evaluation and Research, Guidance for Industry: Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies (May 2013) [hereinafter cited as CBER Report July 2013].Google Scholar
See E. van Nood et al., supra note 18.Google Scholar
See CBER Report July 2013, supra note 38.Google Scholar
Center for Biologics Evaluation and Research, Draft Guidance for Industry: Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies (March 2014) [hereinafter cited as CBER Report March 2014].Google Scholar
Center for Biologics Evaluation and Research, Draft Guidance for Industry: Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies (March 2016) [hereinafter cited as CBER Report March 2016].Google Scholar
Sachs, R.E. and Edelstein, C.E., “Ensuring the Safe and Effective FDA Regulation of Fecal Microbiota Transplantation,” Journal of Law and the Biosciences 2, no. 2 (2015): 396415; Hoffmann, D.E. et al., “Improving Regulation of Microbiota Transplants,” Science 358, no. 3639 (2017): 13901391; See C.A. Edelstein, Z. Kassam, J. Daw, M.B Smith, and C.R. Kelly, supra note 25.CrossRefGoogle Scholar
21 § CFR 1271.3 (2001).Google Scholar
See R.E. Sachs and C.E. Edelstein, supra note 44 at 410-411.Google Scholar
Id. at 411.Google Scholar
See CBER Report July 2013, supra note 38.Google Scholar
See C.M. Surawicz et al., supra note 4 at 479.Google Scholar
See C. Kelly et al., supra note 1 at 224.Google Scholar
Moore, T., Rodriguez, A., and Bakken, J.S., “Fecal Microbiota Transplantation: A Practical Update for the Infectious Disease Specialist,” Clinical Infectious Diseases 58, no. 4 (2014): 541545 at 542.CrossRefGoogle Scholar
Panchal, P. et al., “Scaling Access to Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in the United States: A Geospatial Time-Series Analysis from 2013 to 2017,” Gastroenterology Journal 154, no. 6 Supplement 1 (2018): S-190–S-191.CrossRefGoogle Scholar
See OpenBiome, Press Release, In Its Fifth Year, OpenBiome Reaches Major Milestone In Expanding FMT Access: 40,000 Treatments Shipped, October 5, 2018), available at <https://www.openbiome.org/press-releases/2018/10/5/in-its-fifth-year-openbiome-reaches-major-milestone-in-expanding-fmt-access-40000-treatments-shipped> (last visited July 27, 2019).+(last+visited+July+27,+2019).>Google Scholar
List Results, ClinicalTrials.gov, available at <https://clinicaltrials.gov/ct2/results?term=%22fecal+transplant%22&cntry=US&Search=Apply&recrs=a&recrs=f&recrs=d&age_v=&gndr=&type=&rslt=> (last visited April 29, 2019); Ossorio, P. N. and Zhou, Y., “FMT and Microbial Medical Products: Generating High-Quality Evidence through Good Governance,” Journal of Law, Medicine & Ethics 47, no. 4 (2019): 505523, referencing over 300 studies in clinicaltrials.gov.CrossRefGoogle Scholar
Regulatory, OpenBiome, available at <https://www.openbiome.org/regulatory> (last visited July 26, 2019).+(last+visited+July+26,+2019).>Google Scholar
Health Canada, Fecal Microbiota Therapy Used in the Treatment of Clostridium difficile Infection Not Responsive to Conventional Therapies, March 2015Google Scholar
Moayyedi, P., Marshall, J.K, Yuan, Y., and Hunt, R., “Canadian Association of Gastroenterology Position Statement: Fecal Microbiota Transplant Therapy,” Canadian Journal of Gastroenterology and Hepatology 28, no. 2 (2014): 6668 at 67.CrossRefGoogle Scholar
Loo, V.G. et al., “Association of Medical Microbiology and Infectious Disease Canada Treatment Practice Guidelines for Clostridium difficile Infection,” Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 3, no. 2 (2018): 7192 at 74.CrossRefGoogle Scholar
Sheitoyan-Pesant, C. et al., “Clinical and Healthcare Burden of Multiple Recurrences of Clostridium difficile Infection,” Clinical Infectious Diseases 62, no. 5 (2016): 574580 at 576.CrossRefGoogle Scholar
Edelstein, C., Daw, J.R., and Kassam, Z., “Seeking Safe Stool: Canada Needs a Universal Donor Model,” Canadian Medical Association Journal 188, no. 17-18 (2016): E431E432 at E432.CrossRefGoogle Scholar
Id at E432.Google Scholar
Competent Authorities for Tissues and Cells, Meeting of the Competent Authorities for Tissues and Cells Summary Report, June 2012.Google Scholar
Competent Authorities on Substances of Human Origin Expert Group, Meeting of the Competent Authorities for Tissues and Cells Summary Report, June 2014.Google Scholar
Debast, S.B., Bauer, M.P., and Kuijper, E.J., “European Society of Clinical Microbiology and Infectious Diseases: Update of the Treatment Guidance Document for Clostridium difficile Infection,” Clinical Microbiology and Infection 20, Supplement 2 (2014): 126 at 18.CrossRefGoogle Scholar
Cammarota, G. et al., “European Consensus Conference on Faecal Microbiota Transplantation in Clinical Practice,” Gut 66, no. 4 (2017): 569580 at 570.CrossRefGoogle Scholar
Davidovics, Z.H. et al., “Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection and Other Conditions in Children: A Joint Position Paper from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition,” Journal of Pediatric Gastroenterology and Nutrition 68, no 1 (2019): 130143 at 139.CrossRefGoogle Scholar
Kump, P.K., Krause, R., Allerberger, F., and Högenauer, C., “Faecal Microbiota Transplantation — the Austrian Approach,” Clinical Microbiology and Infection 20, no. 11 (2014): 11061111 at 1107.CrossRefGoogle Scholar
Email communication between the author and M. Behounek of the Bureau of the Federal Office for Safety in Health Care, May 3, 2019.Google Scholar
Kump, P. et al., “Empfehlungen zur Anwendung der fäkalen Mikrobiotatransplantation Stuhltransplantation: Konsensus der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie,” Zeitschrift für Gastroenterologie 52, no. 12 (2014): 14851492.Google Scholar
Federaal Agentschap voor Geneesmiddelen en Gezondheidsproducten, Advies van de Hoge Gezondheidsraad nr. 9202: Aanbevelingen Betreffende de Therapeutische Indica-ties, dePprocedures, de Veiligheid en deKkwaliteit van de Transplantatie van Fecaal Materiaal, March 2014.Google Scholar
Email communication between the author and R. Van Gelder of the Federal Agency for Medicines and Health Products, May 3, 2019.Google Scholar
Email communication between the author and L. Hemmingsen of the Danish Medicines Agency, June 25, 2019.Google Scholar
Email communication between the author and T. Suvi of the State Agency of Medicines, April 12, 2019.Google Scholar
Email communication between the author and K. Pellas of the Finnish Medicines Agency April 11, 2019.Google Scholar
Lahtinen, P. et al., Faecal Microbiota Transplantation in Patients with Clostridium difficile and Significant Comorbidities as well as in Patients with New Indications: A Case Series,” World Journal of Gastroenterology 23, no. 39 (2017): 71747184 at 7176.CrossRefGoogle Scholar
L'Agence National de Securite du Medicament et des Produits, La Transplantation de Microbiote Fécal et Son Encadrement dans les Essais Cliniques, March 2014.Google Scholar
Sokol, H. et al., “Faecal Microbiota Transplantation in Recurrent Clostridium difficile Infection: Recommendations from the French Group of Faecal Microbiota Transplantation,” Digestive and Liver Disease 48, no. 3 (2016): 242247.CrossRefGoogle Scholar
Email communication between the author and M. Müllers of the Federal Institute for Drugs and Medical Devices, April 2, 2019.Google Scholar
Email communication between the author and S. Cudmore of University College Cork, April 4, 2016.Google Scholar
Prior, A.R., Kevans, D., McDowell, L., Cudmore, S., and Fitzpatrick, F., “Treatment of Clostridium difficile infection: A National Survey of Clinician Recommendations and the Use of Faecal Microbiota Transplantation,” Journal of Hospital Infection 95, no. 4 (2017): 438441 at 440.CrossRefGoogle Scholar
Il Presidente in Qualita' di Comissario ad Acta, Recepimento de Programma Nazionale Trapianto di Microbiota Fecale: Aspetti Regolatori, Clinici e Organizzativi, 2018.Google Scholar
Email communication between the author and H. Vella of the Medicines Authority of Malta, April 25, 2019.Google Scholar
Email communication between the author at F. van Linden of the Health Care and Youth Inspectorate, June 3, 2019.Google Scholar
Terveer, E.M. et al., “How to: Establish and Run a Stool Bank,” Clinical Microbiology and Infection 23, no. 12 (2017): 924930 at 926.CrossRefGoogle Scholar
Id. at 929.Google Scholar
Email communication between the author and K. Odlo Høye of the Norwegian Medicines Agency, April 25, 2019.Google Scholar
Email communication between the author and I. Wojtyra of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, April 15, 2019.Google Scholar
Email communication between the author and L. Leite of the National Authority of Medicines and Health Products, I.P., May 30, 2019.Google Scholar
Email communication between the author and a representative of the Agency for Medicinal Products and Medical Devices of the Republic of Slovenia, April 16, 2019.Google Scholar
Reigadas, E. et al., “Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection: Experience, Protocol, and Results,” Revista Espanola De Quimioterapia: Publicacion Oficial De La Sociedad Espanola De Quimioterapia 31, no. 5 (2018): 411418.Google Scholar
Garcia de Paredes, A.G. et al., “Trasplante de Microbiota Fecal por Colonoscopia para el Tratamiento de la Infección Recurrente por Clostridium difficile,” Asociación Española de Gastroenterología (2019).Google Scholar
Email communication between the author and P. Stadel-mann, supra note 36.Google Scholar
Searching for a clinical trial, Kofam, available at <https://www.kofam.ch/en/snctp-portal/searching-for-a-clinical-trial/?sid=49029> (last visited April 30, 2019).+(last+visited+April+30,+2019).>Google Scholar
Medicines Borderline Section, Faecal Microbiota Transplantation (FMT): MHRA's Position, June 2015.Google Scholar
Regulation of faecal microbiota transplant (June 3, 2015), Human Tissue Authority, available at <https://www.hta.gov.uk/policies/regulation-faecal-microbiota-transplant> (last visited March 7, 2019).+(last+visited+March+7,+2019).>Google Scholar
National Institute for Health and Care Excellence, Faecal Microbiota Transplant for Recurrent Clostridium difficile Infection: Interventional Procedures Guidance, March 27, 2014.Google Scholar
Public Health England, Updated Guidance on the Management and Treatment of Clostridium difficile Infection, May 2013.Google Scholar
Mullish, B.H et al., “The Use of Faecal Microbiota Transplant as Treatment for Recurrent or Refractory Clostridium difficile Infection and Other Potential Indications: Joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) Guidelines,” Gut 67, no. 11 (2018): 19201941 at 1920-1921.CrossRefGoogle Scholar
Quraishi, M.N. et al., “National Survey of Practice of Faecal Microbiota Transplantation for Clostridium difficile Infection in the UK,” Journal of Hospital Infection 95, no. 4 (2017): 444445.CrossRefGoogle Scholar
Email communication between the author and T. O'Reilly of the Therapeutic Goods Association, November 30, 2015.Google Scholar
See Therapeutic Goods Administration, supra note 34.Google Scholar
Gastroenterological Society of Australia, Position Statement on Faecal Microbiota Transplant (FMT), September 2015, available at <http://www.gesa.org.au/public/13/files/GESA%20position%20statement%20FMT%20FAM%20JMA%20SPC%2020170426.pdf> (last visited July 28, 2019).+(last+visited+July+28,+2019).>Google Scholar
Trubiano, J.A. et al., “Australasian Society of Infectious Diseases Updated Guidelines for the Management of Clostridium difficile Infection in Adults and Children in Australia and New Zealand: CDI Management Guidelines,” Internal Medicine Journal 46, no. 4 (2016): 479493 at 485.CrossRefGoogle Scholar
See Professor Thomas Borody, supra note 35.Google Scholar
See Gastroenterological Society of Australia, supra note 103.Google Scholar
Email communication between the author and S. Reader of the Medicines and Medical Devices Safety Authority, December 3, 2015.Google Scholar
Email communication between the author and M. Chan of the Department of Health, April 9, 2019.Google Scholar
Information for Patients | Overview, Asia Microbiota Bank, available at <http://asiabiobank.com/for-patients/overview/> (last visited April 30, 2019).+(last+visited+April+30,+2019).>Google Scholar
Medical Directorate, “Stool Transplant,” May 29, 2017.Google Scholar
Email communication between the author and a representative of the Therapeutic Products Branch, April 12, 2019.Google Scholar
Jangi, S. et al., “Alterations of the Human Gut Microbiome in Multiple Sclerosis,” Nature Communications 7, no. 1 (2016): 111 at 7-8; Qin, Y. et al., “An Obesity-Associated Gut Micro-biome Reprogram the Intestinal Epigenome and Leads to Altered Colonic Gene Expression,” Genome Biology 19, no. 1 (2018): 114 at 4; Wolpe, P.R., “A Human Head Transplant Would Be Reckless and Ghastly. It's Time to Talk About It,” Vox, June 12, 2018, available at <https://www.vox.com/the-big-idea/2018/4/2/17173470/human-head-transplant-canavero-ethics-bioethics> (last visited August 3, 2019); Felix, D. St., “New Shit,” The College Hill Independent, February 28, 2014, available at <https://www.theindy.org/270> (last visited August 3, 2018).CrossRefGoogle Scholar
Kelly, C.R. et al., “Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial,” Annals of Internal Medicine 165, no. 9 (2016): 609616.CrossRefGoogle Scholar
Lee, C.H. et al., “Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients with Recurrent Clostridium difficile Infection: A Randomized Clinical Trial,” Journal of the American Medical Association 315, no. 2 (2016): 142149.CrossRefGoogle Scholar
Kao, D. et al., “Effect of Oral Capsule-vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial,” JAMA 318, no. 20 (2017): 19851993.CrossRefGoogle Scholar
Cammarota, G. et al, “Randomised Clinical Trial: Faecal Microbiota Transplantation by Colonoscopy vs. Vancomycin for the Treatment of Recurrent Clostridium difficile Infection,” Alimentary Pharmacology & Therapeutics 41, no. 9 (2015): 835843.CrossRefGoogle Scholar
Youngster, I. et al., “Fecal Microbiota Transplant for Relapsing Clostridium difficile Infection Using a Frozen Inoculum From Unrelated Donors: A Randomized, Open-Label, Controlled Pilot Study,” Clinical Infectious Diseases 58, no. 11 (2014): 15151522.CrossRefGoogle Scholar
van Nood, E. et al,. “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile,” New England Journal of Medicine 368 no 5 (2013): 407415.CrossRefGoogle Scholar
Quraishi, M. N. et al., “Systematic Review with Meta-Analysis: The Efficacy of Faecal Microbiota Transplantation for the Treatment of Recurrent and Refractory Clostridium Difficile Infection,” Alimentary Pharmacology & Therapeutics 46, no. 5 (2017): 479493.CrossRefGoogle Scholar
Moayyedi, P., Yuan, Y., Baharith, H., and Ford, A., “Faecal Micro-biota Transplantation for Clostridium difficile Associated Diarrhoea: A Systematic Review of Randomised Controlled Trials,” The Medical Journal of Australia 207, no. 4 (2017): 166172.CrossRefGoogle Scholar
Drekonja, D. et al., “Fecal Microbiota Transplantation for Clostridium difficile Infection: A Systematic Review,” Annals of Internal Medicine 162, no. 9 (2015): 630638.CrossRefGoogle Scholar
Cammarota, G., Ianiro, G., and Gasbarrini, A., “Fecal Microbiota Transplantation for the Treatment of Clostridium difficile Infection: A Systematic Review,” Journal of Clinical Gastroenterology 48, no. 8 (2014): 693702.CrossRefGoogle Scholar
Kassam, Z., Lee, C.H., Yuan, Y., and, Y. Hunt, R.H., “Fecal Micro-biota Transplantation for Clostridium difficile Infection: Systematic Review and Meta-Analysis,” The American Journal of Gastroenterology 108, no. 4 (2013): 500508 at 505; Cammarota, G. et al., “Randomised Clinical Trial: Faecal Microbiota Transplantation by Colonoscopy vs. Vancomycin for the Treatment of Recurrent Clostridium difficile Infection,” Alimentary Pharmacology and Therapeutics 41, no. 8 (2017): 835843.CrossRefGoogle Scholar
Youngster, I. et al., “Oral, Frozen Fecal Microbiota Transplant (FMT) Capsules for Recurrent Clostridium difficile Infection,” BioMed Central Medicine 14, no. 1 (2016): 134.Google Scholar
Hirsch, B.E. et al., “Effectiveness of Fecal-Derived Microbiota Transfer Using Orally Administered Capsules for Recurrent Clostridium difficile Infection,” BioMed Central Infectious Diseases 15, no. 1 (2015): 191.CrossRefGoogle Scholar
Youngster, I. et al., “Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection,” JAMA 312, no. 17 (2014): 17721778.CrossRefGoogle Scholar