Fecal transplantation for recurrent Clostridium difficile colitis, an underused treatment modality

Recently we successfully treated a patient who suf- fered from recurrent Clostridium difficile colitis with a fecal transplant (fecal bacteriotherapy) from a first degree relative. To our knowledge this is the first case of a successful transplant of this kind in Belgium. Also of interest is the fact that in our patient a cure was obtained using the supernatant after centrifugation of the fecal material. The patient was a 59-year-old woman with lithium induced chronic renal failure who presented with four episodes of clinically and endoscopically severe Clostridium difficile colitis. No typing of the strain was done. The first episode occurred after treatment of an infected wound on one of her toes with amoxicillin- clavulanic acid. She was not receiving proton pump inhibitors nor was she immunocompromised. The first attack was treated with five days of metronidazole 3 ?? 500 mg/day and because of persisting symptoms an additional ten days of oral vancomycin 4 ?? 500 mg/day. The second and third episodes were treated with two weeks of oral vancomycin 4 ?? 500 mg/day and a tapered/pulsed scheme of vancomycin (1, 2). However, each time only a few days after stopping treatment the patient relapsed.