Guidance provided for fecal microbiota transplantation in children

For pediatric patients, fecal microbiota transplantation (FMT) is recommended for moderate-to-severe or recurrent Clostridioides difficile infection (CDI), according to a clinical report published online Nov. 20 in Pediatrics.

Noting that current evidence supports the use of FMT for treatment of CDI in adults, Maria Oliva-Hemker, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues provided an overview of the use of FMT for children to facilitate appropriate guidance for families interested in FMT treatment.

The authors note there are no prospective clinical trials in children using FMT for CDI treatment. However, for pediatric patients with moderate-to-severe or recurrent CDI, studies support FMT use. To date, FMT is not recommended for clinical treatment of other medical conditions.

For safety reasons, do-it-yourself, at-home FMT should not be performed in children. FMT should be performed in a center with adequate experience with the procedure. Regulatory standards are lacking for fecal preparations for FMT. The long-term effects of FMT are currently unknown. Rapid advances are anticipated in the field of antimicrobial therapies, which will potentially bring commercial products for the treatment of CDI.

"Although the anticipated benefit of these commercial microbiota therapeutics is appealing, they will likely come with their own set of challenges for children," the authors write. "It is also important to advocate that clinical trials for microbial therapeutic products include pediatric populations."

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