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Randomized Controlled Trial
. 2022 Jan-Dec;14(1):2020067.
doi: 10.1080/19490976.2021.2020067.

Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D

Prashant Singh  1 , Eric J Alm  2 , John M Kelley  3   4 , Vivian Cheng  5 , Mark Smith  6 , Zain Kassam  6 , Judy Nee  5 , Johanna Iturrino  5 , Anthony Lembo  5
Affiliations
Randomized Controlled Trial

Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D

Prashant Singh et al. Gut Microbes. 2022 Jan-Dec.

Abstract

Fecal microbiota transplantation (FMT) is an attractive strategy to correct microbial dysbiosis in diarrhea-predominant irritable bowel syndrome (IBS-D). Although the mechanism of FMT is thought to be bacterial engraftment, the best approach to achieve engraftment after FMT in IBS-D (and other diseases) is not clear. We evaluated the effect of FMT (with or without pretreatment with antibiotics) on gut microbiome and symptoms in patients with IBS-D. In this randomized, placebo-controlled, single-center study, 44 patients with IBS-D with a least moderate severity (IBS severity scoring system, i.e., IBS-SSS, ≥175) were randomly assigned to one of four groups: single-dose oral FMT alone, single-dose oral FMT following a 7-day pretreatment course of Ciprofloxacin and Metronidazole (CM-FMT) or Rifaximin (R-FMT), or Placebo FMT. Primary endpoint was engraftment post-FMT and secondary endpoints were changes in IBS-SSS, and IBS-quality of life (IBS-QOL) at week 10. Median engraftment was significantly different among the three FMT groups (P = .013). Engraftment post-FMT was significantly higher in the FMT alone arm (15.5%) compared to that in R-FMT group (5%, P = .04) and CM-FMT group (2.4%, P = .002). The mean change in IBS-SSS and IBS-QOL from baseline were not significantly different among the four groups or between the three FMT groups combined vs. placebo at week 10. In summary, antibiotic pretreatment significantly reduced bacterial engraftment after FMT in patients with IBS-D.

Trial registration: ClinicalTrials.gov NCT02847481.

Keywords: Microbiome; dysbiosis; fecal microbiota transfer; fecal therapy.

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Conflict of interest statement

Mark Smith and Zain Kassam are employees/shareholders of Finch Therapeutics

Figures

Figure 1.
Figure 1.
Study consort diagram.
Figure 2.
Figure 2.
Effect of FMT (with and without antibiotic pretreatment) on bacterial engraftment averaged for week 1 and week 10 in patients with IBS-D.
Figure 3.
Figure 3.
Effect of antibiotic pretreatment and FMT on alpha-diversity at various time-points in patients with IBS-D.
Figure 4.
Figure 4.
Effect of antibiotic pretreatment and FMT on microbial composition in IBS-D.
Figure 5.
Figure 5.
Engraftment rates averaged for week 1 and week 10 between IBS-D responders and non-responders.
See this image and copyright information in PMC

References

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