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Rectal bacteriotherapy (RBT) is an investigational live biotherapeutic product developed as an alternative to fecal microbiota transplantation (FMT) for treating recurrent Clostridioides difficile infection (rCDI). [9, 11] It is composed of a standardized, laboratory-cultured mixture of a fixed number of intestinal bacterial strains (commonly 10 or 12) that were originally isolated from the feces of healthy donors. [2, 3, 14] Administered as a rectal enema, RBT aims to restore a healthy gut microbiome, which creates an environment that is resistant to C. difficile colonization and spore germination, thereby preventing infection recurrence. [2, 6] Clinical studies have compared RBT to standard-of-care antibiotics like vancomycin and to FMT, with results suggesting its efficacy is comparable to vancomycin but generally lower than that of FMT. [1, 8] The therapeutic approach was originally developed in Denmark by Dr. Tvede and Dr. Rask-Madsen. [2, 13]
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