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FMT and Antibiotics

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Ulcerative Colitis
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Posted 2/21/2016 9:51 AM (GMT 0)
hi,

The process for FMT was explained to me by the CDD. All seems fine except they want me to go on a course of antibiotics before the FMT. I specifically asked if it was broadband and they said no, it was as targeted as possible. The two antibiotics are rifaximin and vancomycin. I did some research and read some papers - rifaxmin seems harmless enough and is quite targeted. Vancomycin on the other hand is target - mainly targeting C. Diff which I don't have - but has some collateral damage to other breeds.

I am of two minds as I have avoided antibiotics ever since I got this disease 30 years ago as I believe it was antibiotics that caused the disease in the first place. I wondered what people thought and if I skipped them would I be jeopardising the chances of successful transplant. CDD says its a requirement for success.

Thanks.
Posted 2/21/2016 9:57 AM (GMT 0)
This is my thinking behind NOT taking antibiotics be4 fmt.
Besides rifaximin, most other antibiotics are systemic.they get absorbed into your bloodstream. So when fmt takes place, even if the bacteria gets a foothold, it will most probably be killed by the antibiotics in your bloodstream.

But then again, yr doc has first hand experience with other patients who have gone the antibiotic route... soo ultimately..... you can crooss yr fingers and hope the option u take benefits you.

Gl
Posted 2/21/2016 11:12 AM (GMT 0)
Thanks for the reply - to be clear, the antibiotics will not be taken during the FMT. They are taken for two weeks before, stopped the day before the first FMT via colonoscopy. Then there are two weeks of FMT via enema. No antibiotics at this time.
Posted 2/21/2016 3:09 PM (GMT 0)
It does take a while for antibiotics to be cleared from your system doesnt. Moreover even if you stop antibiotics a week say, before the fmt, other sets of bacteria would take the place of previously existing flora ...obviously in lower no.s
But then again..i think its a good idea to ask your doc if he has clinically treated patients who were more successful on antibiotics before fmt. That would be a good start
Posted 2/21/2016 4:25 PM (GMT 0)
They have to go by books but we have the option to go by common sense of course with some risks.
I did FMT (5 months in total) on my own at home with out any pre-screening and antibiotics. Then again donor was my son so I felt comfortable.
Posted 2/22/2016 11:05 PM (GMT 0)
Lots of controversies on this. Certainly seems reasonable to want to clear out existing colonic bacteria before infusing new ones. But surprisingly, studies have shown it doesn't make that much of a difference and it may even be better in some cases to not do the initial antibiotic treatment.
Posted 2/22/2016 11:34 PM (GMT 0)
if it were me, i would pass on the antibiotics - if that meant going a different route for FMT, so be it -
Posted 2/23/2016 10:14 AM (GMT 0)
I am leaning that way personally. I was actually interested if anyone had used these antibiotics and had any observable bad side effects.
Posted 2/23/2016 3:27 PM (GMT 0)
I did rifaximin without issue. I've never had c diff, so no vanco.

As with anything, I think antibiotics effect all of us differently. Some people feel better while on antibiotics, other people end up flaring up from them. We have also had members go into remission from antibiotics. I took them when my condition was nearly beyond repair a few times. I never had anything go awry any worse than it already was. You need to weigh the pros and cons for you. it sounds like you believe your UC was caused by antibiotics, that would make me want to avoid them, but you really never know, maybe they will help you. I doubt they are trying to make you take them for no reason. There must be scientific backup suggesting that FT is more effective after antibiotics.
Posted 2/24/2016 12:39 AM (GMT 0)
True. There success rate with UC is 80% over the 20+ years of providing the treatment. Almost 100% treating c.diff. I didn't ask about other diseases. I also know when they did their first trial back in the early 90s it was on UC and they used broadband antibiotics to kill as many bacteria as possible. So they have definitely refined there process over the years.

Happy to report the results here as it progresses.
Posted 2/24/2016 10:49 AM (GMT 0)
I've had FMT both with and without antibiotics on two separate occasions and surprisingly the antibiotics made a huge difference. I can only put it down to the bugs being able to take hold more effectively, but it made about a 30% difference, and was already about 60% improvement without antibiotics so I would definitely recommend it. And I'm a person who avoids antibiotics at all costs, but the FMT undoes all the damage
Posted 2/24/2016 11:20 AM (GMT 0)
Thanks WorriedUC! That's helpful.
Posted 3/15/2016 11:05 AM (GMT 0)
Hi all,
Halfway through the antibiotic treatment. Notes:

  • My symptoms have improved and I was able to reduce my medication
  • My BMs are a lot healthier and regular
  • On the downside I seem to have multiple BMs a day now, though they all look healthy frequency is too high


Definitely some changes going on.
Posted 3/29/2016 11:00 AM (GMT 0)
Antibiotic treatment is complete and I am halfway through my FMT process. I'll post separately on that but specific to the 14 day course of these antibiotics:

  • By day 10 of the antibiotics I found I was very very flatulent. Almost constantly. Fortunately they were odourless so I could live with it.
  • However by day 10 I was also having 4 to 6 bowl movements a day - all healthy though the bulk of each decreased as the frequency increased. I still felt it was too many.
  • I stopped the vancomycin for day 11 and day 12 and the BM frequency and flatulence returned to more normal levels.
  • I re-added the vancomycin on day 13 and 14 and didn't see a relapse of these symptoms.
  • I took rifaximin the entire 14 days.


The first FMT dose was delivered via colonoscopy and after the procedure the doctor said my UC had improved a lot since the last colonoscopy six months before. Looking at the two pictures the redness of the inflammation had decreased to a much smaller area. As the only thing I changed was taking the antibiotics it seemed I have them to thank for the remission. Though, from what I have read, due to the many side-affects of antibiotics they are not considered a longterm solution for UC and related diseases. It does imply some strain of bacteria was overgrown/dominant where it shouldn't be.

In retrospect I wouldn't hesitate recommending this treatment as a lead in to FMT.
Posted 3/29/2016 6:06 PM (GMT 0)
Thanks Solomani. Please continue to keep us posted on your progress. FMT is a very interesting path for this disease.
B
Posted 3/30/2016 12:49 AM (GMT 0)
Assume they know what they're talking about. Take 'em. The FMT should overwhelm them.
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