16 November 2023
News: Draft Guidelines Released for External Consultation on the Use of Faecal Microbiota Transplant as Treatment for Recurrent or Refractory Clostridioides difficile Infection and Other Potential Indications
In a step toward advancing medical treatment options, the British Society of Gastroenterology (BSG) alongside the Healthcare Infection Society (HIS) have released a set of draft guidelines for external consultation.
Closing date for comments: 9am on Thursday, 14 December 2023.

In a step toward advancing medical treatment options, the British Society of Gastroenterology (BSG) alongside the Healthcare Infection Society (HIS) have released a set of draft guidelines for external consultation on the use of Faecal Microbiota Transplant (FMT) as a potential therapy for recurrent or refractory Clostridioides difficile infection (CDI), and other indications.

Clostridioides difficile (formerly Clostridium) – also called C. difficile, or informally just ‘C. diff’ – is a major cause of healthcare associated diarrhoea, and is increasingly present in the community [1]. Since its recognition as a significant healthcare associated infection, multiple infection control measures and treatment modalities have been explored and this remains an evolving field [2].

FMT, a procedure involving the transfer of screened healthy donor faeces into an affected patient's gastrointestinal tract, has gained increasing attention in recent years for its potential to treat various gastrointestinal disorders (especially recurrent or refractory CDI), and even disorders beyond the gut.

The guidelines serve as an update to the first version of the joint BSG/ HIS FMT guidelines, first published in 2018, and reflect the fast moving updates in the literature since this point.  They have been developed through extensive collaboration between experts in the field, and provide a comprehensive framework for healthcare professionals to understand and evaluate the use of FMT for treatment of C. difficile and, potentially, for other conditions. The primary focus of these guidelines is to standardise the clinical and research aspects of FMT to ensure its safety and efficacy.

Key points addressed in the draft guidelines include:

  1. Patient Selection: Recommendations for identifying suitable candidates for FMT, particularly for those with recurrent or refractory difficile infection.
  2. Donor Screening: Protocols for donor screening and selection to minimise potential risks and ensure recipient safety.
  3. FMT Procedure: Protocols for the procedure itself, including preparation, when it should be offered, and the best ways to administer it.
  4. Research: Encouraging further research to expand FMT applications and improve its effectiveness.

The draft guidelines are now open for external consultation, allowing healthcare professionals, researchers, and other stakeholders to provide feedback and input to refine and enhance the recommendations. This external consultation period is essential to ensure that the guidelines are, safe, and effective for patients.

Benjamin Mullish, Chair of the FMT working party and one of the principal authors of the draft guidelines, stated, "These guidelines represent a significant step toward standardising and regulating the use of FMT, ensuring the best possible outcomes for patients while upholding the highest standards of safety for this major healthcare associated infection."

Stakeholders are encouraged to review the draft guidelines and provide feedback during the consultation period, which will remain open for the next 28 days. After the consultation period, the guidelines will be finalised and published for broader use within the medical community.

Click here to access the draft guidelines and participate in the external consultation.


[1] Guery B, Galperine T, Barbut F. Clostridioides difficile: diagnosis and treatments BMJ 2019; 366 :l4609 doi:10.1136/bmj.l4609

[2] McGuire E, Brown C, Islam J. Clostridioides difficile infection: Updated guidance on management and treatment (draft). UKHSA 2002.

Gut Microbiome (1)