Duodenal Infusion of Feces for Recurrent Clostridium difficile

To the Editor: Van Nood et al. (Jan. 31 issue) 1 found fecal microbiota therapy to be superior to vancomycin for the treatment of recurrent Clostridium difficile infection, but the results of their study should be interpreted with caution. Small, index trials such as this one are vulnerable to exaggerated treatment effects, and subsequent trials typically show decreased effects. 2 Even though the trial was randomized, the results may have been influenced by inequalities among the three treatment groups in terms of either the number of pretreatment recurrences of C. difficile infection or post-treatment exposure to an antimicrobial agent or proton-pump inhibitor . . .