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Wednesday, September 30, 2020  Spokane, Washington  Est. May 19, 1883
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Anti-diarrhea bacteria used in pill form

Anthony L. Komaroff M.D.

DEAR DOCTOR K: I overheard a colleague talking about “poop pills” used to treat diarrhea. That can’t be right. Can it?

DEAR READER: Yes, “poop” means what you think it means. Same thing as “doo-doo.” It’s gross, but it’s true. So-called “poop pills” are being used to treat diarrhea caused by bacteria called Clostridium difficile, or “C. diff.”

Our intestines are filled with many different kinds of bacteria. C. diff bacteria live in our guts, but in low numbers because other bacteria in the intestine out-compete them for nutrients.

The problem starts with antibiotic treatment. Every antibiotic is good at killing some types of bacteria, while having no effect on other types. A doctor chooses a particular antibiotic based on the type of bacterial infection that is being treated.

Most of the antibiotics used to kill pneumonia or urinary tract infections also kill bacteria in the gut that compete with C. diff. However, they often don’t kill C. diff. This leaves a void that allows C. diff to multiply. Once it takes hold in the gut, C. diff creates toxins that cause diarrhea, fever, abdominal pain and inflammation that can be life-threatening.

Treatment of C. diff begins by stopping the antibiotic that triggered it in the first place. If that doesn’t work, the doctor prescribes one of a handful of antibiotics that specifically kill C. diff. But C. diff is becoming increasingly resistant to antibiotics.

As the problem of antibiotic resistance has grown, doctors are filling the gut with the bacteria that are C. diff’s normal competitors. They’re treating bad bacteria with large numbers of good bacteria that are abundant in feces.

Researchers at Harvard-affiliated Massachusetts General Hospital have used capsules containing frozen fecal extracts from healthy people to successfully treat diarrhea caused by C. diff.

Disgusting as it sounds, the donor feces are processed so only bacteria remains in the pill. The pill that is swallowed is clean and odorless. It is, essentially, a probiotic pill. And its protective gel cover does not dissolve until it is deep in the digestive tract.

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