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.

November 2019: The US Food and Drug Administration has advised that stool donors for faecal microbiota transplantation should be screened with questions that specifically address risk factors for colonization with Multi Drug Resistant Organisms (MDROs), and individuals at higher risk of colonization with MDROs should be excluded as donors. In addition donor stool should be specifically tested for MDROs and not used if positive.
NICE is currently seeking advice from professional experts on whether to update this guidance.


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 and clinical classification codes for this guidance

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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)