lunes, 21 de enero de 2013

En ocasiones las heces son más útiles que los antibióticos




Consumimos muchos más antibióticos de los necesarios. Nuestra sociedad medicalizada los reclama, y los servicios sanitarios los proveemos. A menudo de forma incorrecta por falta de indicación.

Estos días un equipo holandés ha demostrado que es más útil la infusión de heces de donante en el intestino de un paciente con infección por la bacteria Clostridium difficile, resistente a muchos antibióticos.

Es un ejemplo de creatividad. A nadie se le había ocurrido antes usar heces humanas para tratar una infección.



Ahora bien no se le ocurra comer heces por su cuenta... De momento no tenemos pruebas de que le sirva para sus procesos habituales.


Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile

Els van Nood, M.D., Anne Vrieze, M.D., Max Nieuwdorp, M.D., Ph.D., Susana Fuentes, Ph.D., Erwin G. Zoetendal, Ph.D., Willem M. de Vos, Ph.D., Caroline E. Visser, M.D., Ph.D., Ed J. Kuijper, M.D., Ph.D., Joep F.W.M. Bartelsman, M.D., Jan G.P. Tijssen, Ph.D., Peter Speelman, M.D., Ph.D., Marcel G.W. Dijkgraaf, Ph.D., and Josbert J. Keller, M.D., Ph.D.
January 16, 2013DOI: 10.1056/NEJMoa1205037

Background

Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection.

Methods

We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks.

Results

The study was stopped after an interim analysis. Of 16 patients in the infusion group, 13 (81%) had resolution of C. difficile–associated diarrhea after the first infusion. The 3 remaining patients received a second infusion with feces from a different donor, with resolution in 2 patients. Resolution of C. difficile infection occurred in 4 of 13 patients (31%) receiving vancomycin alone and in 3 of 13 patients (23%) receiving vancomycin with bowel lavage (P<0 .001=".001" a="a" abdominal="abdominal" adverse="adverse" after="after" among="among" an="an" and="and" bacterial="bacterial" bacteroidetes="bacteroidetes" both="both" clostridium="clostridium" clusters="clusters" comparisons="comparisons" cramping="cramping" day.="day." decrease="decrease" diarrhea="diarrhea" differences="differences" diversity="diversity" donor-feces="donor-feces" donors="donors" events="events" except="except" fecal="fecal" for="for" group="group" groups="groups" healthy="healthy" in="in" increase="increase" increased="increased" infusion="infusion" iv="iv" mild="mild" no="no" observed="observed" on="on" p="p" patients="patients" proteobacteria="proteobacteria" showed="showed" significant="significant" similar="similar" species.="species." species="species" study="study" that="that" the="the" three="three" to="to" were="were" with="with" xiva="xiva">

Conclusions

The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin. (Funded by the Netherlands Organization for Health Research and Development and the Netherlands Organization for Scientific Research; Netherlands Trial Register number, NTR1177.)


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