Research Summary

AGA Recommends Fecal Microbiota Transplant in Some Adults With Recurrent C difficile Infection

The American Gastroenterological Association (AGA) has developed a new guideline to provide recommendations on the use of fecal microbiota-based therapies in adults with recurrent Clostridioides difficile (C difficile) infection.

Members of the guideline panel, which consisted of three members of the AGA guideline committee, three experts in fecal microbiota-based therapies, and two methodologists, used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework to develop the recommendations for the use of fecal microbiota-based therapies and provided clinicians with suggested ways the treatments could be implanted in clinical practice. Specifically, the panel recommends fecal microbiota transplant for most patients with recurrent C difficile infection.

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For patients hospitalized with severe C difficile infection, the AGA recommends the use of fecal microbiota transplant-based therapies when patients do not respond to the use of standard of care antibiotics. In patients who are mildly or moderately immunocompromised with recurrent C difficile infection, the AGA recommends the select use of conventional fecal microbiota transplant. Further, in severely immunocompromised patients, the AGA suggests against the use of any fecal microbiota-based therapies to prevent recurrent C difficile.

“Conventional fecal microbiota transplant is an adjuvant treatment for select adults hospitalized with severe or fulminant C difficile infection not responding to standard of care antibiotics,” the authors concluded. “Fecal microbiota transplant cannot yet be recommended in other gastrointestinal conditions.”


Peery AF, Kelly CR, Kao D, et al. AGA clinical practice guideline on fecal microbiota-based therapies for select gastrointestinal diseases. Gastroenterology. 2024:166(3):409-434. doi: 10.1053/j.gastro.2024.01.008