Clostridium difficile Diarrhea in Children: Diagnosis, Management, and Prevention

Jonathan D. Crews, MD

Disclosures

January 24, 2014

Management of Pediatric CDI

It is important to ensure that all children with a diarrheal illness are adequately hydrated. This can often be accomplished on an outpatient basis, although some children may require hospitalization for intravenous fluids. Antiperistaltic medications (eg, loperamide) are not recommended in children with CDI, because their use may result in complications through toxin retention.[1]

Discontinuation of the inciting antibiotic should be considered in all children with CDI. This step may be sufficient for the management of children with mild disease.[1] Treatment is not indicated for children found to have asymptomatic C difficile colonization.

Although vancomycin is the only drug currently approved for CDI in children, it is not the recommend first-line agent because of concerns about the emergence of vancomycin-resistant enterococcus. Oral metronidazole (30 mg/kg/day in 4 divided doses) is recommended by the AAP for children with mild to moderate disease who require therapy.[1] Metronidazole is well tolerated in children, although it can cause nausea and the oral formulation has a bitter taste.

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