While poo transplants are being heralded as the future in treating bacterial infections, RMIT gut researcher Dr Paul Bertrand says they should not be used in place of antibiotics, and people should not be encouraged to do it themselves.

Dr Bertrand says a review by Kings College London claiming poo transplants are more effective than antibiotics is misleading. The editorial by Professor Tim Spector from King’s College London and Professor Rob Knight from the University of California San Diego, released today, claims poo transplants have become the treatment of choice in cases of severe infections.

What is the procedure and how does it work?

Poo transplants are simple, unfortunately, so there’s lots of do it yourself websites. People are basically trying to take donor poo, blend it up and use something to inject it up your colon. You do this a few times and hope that the microbiota in the donor poo establishes itself in your colon.

When you go to Google “Faecal Microbiota Transplant”, it’s about the third hit - the do it yourself webpage.

Evidence suggests poo transplants are more effective than antibiotics, is this true?

It is better in cases where it’s antibiotic resistant. So the people who clinically get offered the poo transplant have already generally failed several courses of antibiotics. So the antibiotics haven’t worked already. And then they try the poo transplant. Sometimes it does work, which is a good result for them, but the poo transplant is not done initially, prior to the antibiotics in most cases.

You’ve said antibiotics are effective in most cases but this study seems to say poo transplants are more effective?

The editorial by Spector and Knight does oversell FMT (Faecal Microbiota Transplants) as they did fail to explicitly mention that studies in refs 2-5 are all in recurrent CDI (Clostridium difficile infection). That is, treated with antibiotics first, then CDI comes back, then FMT is tested against an antibiotic. They make it sound like a newly diagnosed patient would only have 20 per cent success with vancomycin (antibiotic)... it should be 80-90 per cent.

What are the downsides?

The problem with all this is the donor. You don’t know what’s in the other person's poo. And they might have latent infections that you don’t know about that their supressing themselves. But once it gets into you it may cause serious problems. The do-it-yourself method, if it were harmless, wouldn’t be a problem. But because there’s a good chance of causing harm with unknown donor poo, we’re mostly not keen on people trying it for any problem.

It is being tried on almost any gastrointestinal problem at the moment, in inflammatory bowel diseases and irritable bowel syndrome for instance. But it’s anecdotal evidence and there are no real controls. People are doing clinical trials to look into it but it’s complex because poo is complex, there’s thousands of types of bacteria and it’s difficult to know what you’re putting in someone.

It’s not regulated in Australia yet, is it likely to be?

In the US it’s classed as a medical device. The idea with regulation is you get consistency and quality control so you know what you’re putting into someone. There’s no regulation (in Australia) so there’s no need to find out what’s in the poo transplant before you do it. This makes the results you get from the transplant difficult to replicate. And so I think probably the Therapeutic Goods Administration (TGA) will have to regulate it in the near future but it might restrict access or it might be to help research, I’m not sure. But everybody can do it at home, so it’s hard to regulate.