The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Faecal microbiota transplant for recurrent clostridium difficile infection, in March 2014.

Description

Clostridium difficile (C. difficile) is a commensal bacterium that lives harmlessly in the gut of approximately 5% of healthy people. The use of broad-spectrum antibiotics and immunosuppressive agents can alter the balance of bacterial species in the gut, resulting in an overgrowth of C. difficile. Symptoms of mild C. difficile infections (CDIs) include purulent watery diarrhoea, abdominal cramps, nausea and dehydration. In more severe cases the infection can cause bloody diarrhoea and fever. In a few people CDIs can lead to pseudomembranous colitis, sepsis, toxic megacolon, colonic rupture, and death. The risk of death increases in patients with multiple comorbidities.

First-line treatment involves rehydration and antibiotic therapy. Clinical responses are generally favourable but some patients have recurrent or refractory CDIs. For these people, further courses of antibiotics are used. An example of management algorithms can be found in Public Health England’s Updated guidance on the management and treatment of Clostridium difficile infection (June, 2013).

Coding recommendations

FMT using a colonoscope:

H21.8 Other specified other therapeutic endoscopic operations on colon

Y37.8 Other specified introduction of other substance into organ NOC

FMT using a nasoduodenal tube:

G57.8 Other specified other operations on duodenum

Y37.8 Other specified introduction of other substance into organ NOC

FMT using a nasogastric tube:

G48.8 Other specified other operations on stomach

Y37.8 Other specified introduction of other substance into organ NOC

FMT via rectal enema: 

H62.8 Other specified other operations on bowel

Y37.8 Other specified introduction of other substance into organ NOC

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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