Optimal Protocol of Fecal Microbiota Transplantation
There is no consensus on the optimal protocol for FMT. Feces can be infused both in the upper or lower gastrointestinal tract. Approximately one-third of patients have received feces through a gastric or nasoduodenal tube, two-thirds through an enema or colonoscope. The overall reported success rate is around 90%. As it is difficult to compare the different protocols and strategies in different case series and case reports, there is currently no consensus on the preferred route of infusion.
Historically, the majority of successfully treated patients received only one treatment with donor feces, although small early series reported multiple infusions.
If given for CDI, approximately 80% of patients received antibiotic treatment for CDI prior to the FMT. For other indications [metabolic syndrome, irritable bowel syndrome (IBS)] there are no reports in the literature of antibiotic pretreatment. A minority of patients receive an oral whole bowel lavage prior to infusion of feces. Although it certifies normal passage of fluids prior to infusing feces, there is no study that compared donor feces with or without a whole bowel lavage. With regard to donor preference, most patients receive donor feces from partners or relatives, whereas healthy volunteers are used in a minority of cases. In our experience, there is no relation between sex-matched or relative-matched feces and success rates.