Can I use antibiotics after a fecal microbiota transplant?

As a patient who has finally beatenC. difficile(C. diff), you might be worried about the infection coming back. You may be reluctant to ever take antibiotics, again. The good news is that most patients successfully treated with fecal microbiota transplant (FMT) don’t develop C. diff-related symptoms again.

You may need take antibiotics at some point in the future to treat other infections. Tell your health care providers about your history of C. diff and then respect the decision of the providers treating you if they decide you need to take an antibiotic.

What are things I can do to protect myself from becoming sick again with C. diff?

Many illnesses (such as upper respiratory infections, “sinus infections” and bronchitis) are caused by viruses, not bacteria, and should not be treated with antibiotics.

  • Prophylaxis before procedures (to prevent potential health issues).
  • Before routine dental appointments in patients with artificial joints.
  • Treatment of urinary tract infections without symptoms.

Other situations for which antibiotics may sometimes be given include diarrheal illness.

  • Clindamycin is associated with C. diff and should never be used by patients who have previously had C. diff infection. (There is almost always another choice that is safer.)
  • Fluoroquinolones and broad spectrum cephalosporins are other antibiotics that put patients at higher risk of C. diff.
  • Safer choices include penicillin, trimethoprim-sulfamethoxazole, intravenous (IV) vancomycin, IV gentamycin or tetracycline.

For some patients, taking probiotics during future courses of antibiotics may be protective against C. diff coming back. Review AGA’s patient education on probiotics and talk to your health care provider about whether probiotics may help you.

  • Probiotics are currently available in a variety of foods (such as yogurt or fermented foods like sauerkraut or kimchi) or as dietary supplements. For example, kefir is a probiotic yogurt drink that contains a number of probiotics. It can be found in the dairy aisle of most large grocery stores. The dose is 5 ounces twice daily (30 minutes before or 1 hour after meals). Begin within 48 hours of the antibiotic course and continue for one week after the antibiotics are finished.

Written by

Written with support from Colleen Kelly, MD, co-chair and principal investigator, AGA Fecal Microbiota Transplantation (FMT) National Registry; Brown University Women's Medicine and Collaborative

Reviewed by

Maria I. Vazquez Roque, MD, MS, assistant professor, division of gastroenterology and hepatology, Mayo Clinic, Jacksonville, Florida