Fecal Microbiota Transplantation in Clostridioides difficile Infection and the Role of a Pharmacist: A Narrative Review
by Sage L. Orlowski, 2025 PharmD Candidate, Soriene N. Ruf, 2025 PharmD Candidate
Abstract:
The Infectious Diseases Society of America defines recurrent Clostridioides difficile infection (rCDI) as “an episode of symptom onset and positive assay result following an episode with positive assay result in the previous 2–8 weeks.” After completing a course of antibiotics to treat the recurrent infection, fecal microbiota transplantation may be utilized prophylactically, as it allows for the restoration of gut microbial diversity to eliminate C. difficile and minimize risk of subsequent infection. Additionally, RebyotaTM (RBL) and VOWSTTM (VOS) are newly FDA-approved commercialized fecal microbiota products indicated for the prevention of recurrence of C. difficile infections. With both medications, oral antibiotics treating CDI should be completed prior to initiating treatment. VOS requires the use of laxatives or bowel preparations prior to the first dose that may not be appropriate for all patients. Pharmacists can play an important role in educating patients about the administration of RBL and VOS, side effects of each medication, the need to avoid systemic antibiotics immediately post-transplant, and hygiene practices to reduce subsequent CDI.
Keywords: Fecal Microbiota Transplantation, Clostridium Infections, Reinfection, Antibiotics, Anti-Bacterial Agents, Education, Gastrointestinal Microbiome
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2025 March/April Table of Contents
Abstract:
The Infectious Diseases Society of America defines recurrent Clostridioides difficile infection (rCDI) as “an episode of symptom onset and positive assay result following an episode with positive assay result in the previous 2–8 weeks.” After completing a course of antibiotics to treat the recurrent infection, fecal microbiota transplantation may be utilized prophylactically, as it allows for the restoration of gut microbial diversity to eliminate C. difficile and minimize risk of subsequent infection. Additionally, RebyotaTM (RBL) and VOWSTTM (VOS) are newly FDA-approved commercialized fecal microbiota products indicated for the prevention of recurrence of C. difficile infections. With both medications, oral antibiotics treating CDI should be completed prior to initiating treatment. VOS requires the use of laxatives or bowel preparations prior to the first dose that may not be appropriate for all patients. Pharmacists can play an important role in educating patients about the administration of RBL and VOS, side effects of each medication, the need to avoid systemic antibiotics immediately post-transplant, and hygiene practices to reduce subsequent CDI.
Keywords: Fecal Microbiota Transplantation, Clostridium Infections, Reinfection, Antibiotics, Anti-Bacterial Agents, Education, Gastrointestinal Microbiome
Download PDF
2025 March/April Table of Contents