The treatment and prevention of Clostridium difficile infection in children will be discussed here. The pathogenesis, epidemiology, clinical features, and approach to diagnosis are discussed separately. (See "Clostridium difficile infection in children: Microbiology, pathogenesis, and epidemiology" and "Clostridium difficile infection in children: Clinical features" and "Clostridium difficile infection in children: Approach to diagnosis".)
C. difficile infection in adults also is discussed separately. (See "Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology" and "Clostridium difficile in adults: Clinical manifestations and diagnosis" and "Clostridium difficile in adults: Treatment".)
OVERVIEW OF APPROACH
The management of C. difficile infection in children depends upon the likelihood of infection versus colonization and the severity of infection. In infants and children, it is often difficult to distinguish colonization from disease. Treatment decisions must be individualized, however, since prompt and appropriate treatment of C. difficile disease improves patient outcomes and minimizes the amount of C. difficile that is shed into the environment.
The treatment guidelines presented below are compatible with recommendations of the American Academy of Pediatrics Committee on Infectious Diseases and largely compatible with the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America guidelines for the treatment of C. difficile in adults [1-3].
Asymptomatic carrier — Treatment of asymptomatic carriage is not recommended [1,3]. In a randomized trial, treatment with metronidazole had no effect on colonization in adult carriers . Treatment with vancomycin was temporarily effective but was associated with increased rates of carriage two months after therapy.