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

Jonathan D. Crews, MD

Disclosures

January 24, 2014

Prevention of Antibiotic-Associated Diarrhea

The first step in preventing CDI is to follow the principles of appropriate antibiotic use. Several AAP guidelines are available to assist clinicians in the management of common childhood infections. Most recently, the AAP Committee on Infectious Diseases published a report on antibiotic prescribing for bacterial upper respiratory infections in children.[28]

Probiotics are not currently recommended for the prevention or treatment of CDI.[1,18] Although some evidence suggests that probiotics may prevent antibiotic-associated diarrhea in children, no controlled trials on their use in pediatric CDI have been completed.[29]

C difficile spores can survive in the healthcare environment for months. In hospital settings, providers should use gowns and gloves when entering the room of patients with CDI.[30] The optimal method of hand hygiene is handwashing with soap and water, because alcohol is ineffective in killing C difficile spores. Sodium hypochlorite (household bleach) is frequently used to clean hospital rooms previously occupied by an individual with CDI because most disinfectants are not sporicidal.

Clinical Case Outcome

The 6-year-old boy who presented to your clinic tests positive for C difficile by a molecular-based assay. You prescribe metronidazole orally for 10 days, and his diarrhea improves over the next several days.

Five weeks later, he develops another diarrheal episode consisting of abdominal cramps and up to 8 large, loose stools daily. This episode occurs after he was prescribed amoxicillin for a bout of sinusitis. He again tests positive for C difficile. You prescribe another 10-day course of metronidazole for this first recurrence of CDI and reassess whether he needs the proton pump inhibitor that he is taking. After starting metronidazole treatment, the patient fully recovers from his symptoms and has no further CDI episodes.

As a result of increasing incidence, it is important for pediatric healthcare providers to understand the presentation, management, and prevention of pediatric CDI. The AAP guidelines provide an excellent reference to inform clinicians on the appropriate testing and treatment for CDI in children.

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