The practice of FMT, however, is still not common or
routine among gastroenterologists in the US. Recently, the
FDA determined that FMT is a biological drug and needs to
be regulated.
Part of that regulation is that clinicians using
FMT as a treatment need to submit a treatment protocol,
and an IRB approval from their institute to obtain an IND
number from the FDA. A sponsor of an IND has to conduct
their work in accordance with the protocol described in the
25
IND, report any deviations, and file reports, among other
duties. This is an intensive process, but thankfully, for now
the FDA has decided to use their executive discretion and
not enforce the IND process. It remains to be seen how long
this will continue before an increased regulatory oversight of
one kind or another is going to be imposed. The indications
and best methods of administration are being published in
more papers in recent years and may help to evolve guidelines
and
procedures
for
FMT.
Further
research
is
important
to
establish
different
effective
methods
to
administer
FMT.
More
recently,
FMT via ingestion of fecal microbes contained
in
double
over-encapsulated
gelatin
capsules
has
been
described
in
an
abstract
presented
at
the
ID
Week
conference
in
San
Francisco
in
2013;
this
delivery
method
appears
to
be a convenient and effective approach to arrest the cycle of
recurrent CDI.
27