The American Academy of Pediatrics provides guidance for pediatricians on the use of fecal microbiota transplantation in children within a new clinical report that looks at the promising uses of the procedure and what remains unknown. Fecal microbiota transplantation has been successful in treating a potentially life-threatening infection,
Clostridioides difficile.
Difficult cases of C. Diff
The clinical report, "Guidance for the Clinician in Rendering Patient Care Fecal Microbiota Transplantation: Information for the Pediatrician," is published in the December 2023 issue of
Pediatrics. The report, written by the Section on Gastroenterology, Hepatology and Nutrition and Committee on Infectious Diseases, recommends the use of fecal microbiota transplantation in children with a moderate to severe or a recurrent infection of
Clostridioides difficile, also called CDI or C diff.
The microbial ecosystem in the gut can be disrupted, including by antibiotics taken for bacterial infections, said Maria Oliva-Hemker, MD, FAAP, lead author of the report. Children can also pick up C. Diff in the community. This infection can cause serious issues for children, especially those who have chronic health conditions, Dr. Oliva-Hemker said.
Transplanting "good" bacteria into the gut
Fecal microbiota transplantation involves the transfer of stool from a healthy donor to another individual, to replace "good" bacteria in the gut that has sometimes been destroyed by use of antibiotics.
In adults, the fecal transplantation method has an approximately 80-90% cure rate for
C. diff. infection, and some research finds similar results for children. This success has led to increasing interest in fecal transplantation as a therapeutic intervention for other conditions associated with disturbances of the intestinal microbiome, including inflammatory bowel diseases, autism spectrum disorder, and obesity.
Yet evidence for its use in treating other conditions is inconclusive and lacking in children.
Treatment standards needed
The AAP does not recommend the treatment for any other medical conditions in children at this time. It also strongly discourages do-it-yourself transplants at home for safety reasons.
Fecal microbiota transplantation should always be performed in a center with experience in the procedure. The AAP notes that there is a lack of regulatory standards for fecal preparations used in this treatment. And while the long-term effects of fecal microbiota transplantation are unknown, according to the AAP, the clinical report authors say that the field of microbial therapies is anticipated to quickly advance.
This clinical report endorses the joint society statement by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition.
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