. 2014 Sep 4;108(5):355–359. doi: 10.1093/qjmed/hcu182

Table 2.

Conventional indications and contraindications for use of FMT in the treatment of CDI (adapted from Bakken et al.¹²^,^a)

Indications	Contraindications
Recurrent or relapsing CDI: At least three episodes of mild-to-moderate CDI and failure of a tapering vancomycin regimen, with or without an alternative antibiotic. At least two episodes of severe CDI resulting in hospitalization and associated with significant morbidity. Moderate CDI not responding to standard therapy (vancomycin) for at least a week. Severe (and perhaps even fulminant) C. difficile colitis with no response to standard therapy after 48 h.	Life-threatening food allergies, e.g. nut allergy. Pregnancy or lactation. Contraindication to preferred means of administration, e.g. oesophageal stricture limiting nasogastric tube insertion. Patients with decompensated cirrhosis, uncontrolled HIV (CD4 count < 240 cells/mm³), recent bone marrow transplant (within past 6 weeks), or other significant immunodeficiency. Patients taking major immunosuppressive agents, including high dose corticosteroids (e.g. prednisolone ≥ 60 mg/day), calcineurin inhibitors, mTOR inhibitors, lymphocyte-depleting biologic agents, anti-TNF therapy, and recent use of chemotherapeutic anti-neoplastic agents (past 6 weeks).

Indications

Contraindications

Recurrent or relapsing CDI:
- At least three episodes of mild-to-moderate CDI and failure of a tapering vancomycin regimen, with or without an alternative antibiotic.
- At least two episodes of severe CDI resulting in hospitalization and associated with significant morbidity.
Moderate CDI not responding to standard therapy (vancomycin) for at least a week.
Severe (and perhaps even fulminant) C. difficile colitis with no response to standard therapy after 48 h.

Life-threatening food allergies, e.g. nut allergy.
Pregnancy or lactation.
Contraindication to preferred means of administration, e.g. oesophageal stricture limiting nasogastric tube insertion.
Patients with decompensated cirrhosis, uncontrolled HIV (CD4 count < 240 cells/mm³), recent bone marrow transplant (within past 6 weeks), or other significant immunodeficiency.
Patients taking major immunosuppressive agents, including high dose corticosteroids (e.g. prednisolone ≥ 60 mg/day), calcineurin inhibitors, mTOR inhibitors, lymphocyte-depleting biologic agents, anti-TNF therapy, and recent use of chemotherapeutic anti-neoplastic agents (past 6 weeks).

^aAs described in the text, arguments have been made for using FMT earlier in the clinical course of CDI;¹⁶ it may be that the concerns regarding the risk of FMT to treat CDI in immunosuppressed states have been overestimated.⁶