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Clostridium difficile infection in children: Treatment and outcome

Jonathan Crews, MD, MS
Section Editor
Sheldon L Kaplan, MD
Deputy Editor
Mary M Torchia, MD


Clostridium difficile is an important cause of antibiotic-associated diarrhea and one of the most common healthcare-associated infections [1]. It causes a wide spectrum of illnesses from asymptomatic colonization or mild diarrhea to fulminant disease characterized by toxic megacolon, sepsis, and death. C. difficile infection is less common in children than adults, but the incidence of C. difficile infection in children is increasing [2-5].

The treatment of and outcomes associated with C. difficile infection in children will be discussed here. The pathogenesis, epidemiology, clinical features, diagnosis, and prevention of C. difficile are discussed separately. (See "Clostridium difficile infection in children: Microbiology, pathogenesis, and epidemiology" and "Clostridium difficile infection in children: Clinical features and diagnosis" and "Clostridium difficile infection: Prevention and control".)

C. difficile infection in adults also is discussed separately. (See "Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology" and "Clostridium difficile infection in adults: Clinical manifestations and diagnosis" and "Clostridium difficile in adults: Treatment".)

There is limited high-quality evidence to guide the management of pediatric C. difficile infection. Most treatment recommendations are extrapolated from studies performed in adults. The treatment guidelines presented below are largely compatible with the recommendations of the American Academy of Pediatrics Committee on Infectious Diseases (2015), the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America guidelines for the treatment of C. difficile in adults (2010), and the American College of Gastroenterology (2013) [6-8].


Discontinuation of inciting antibiotics — Discontinuation of the inciting antibiotic is important in the management of C. difficile infection [6-8]. The use of concomitant antibiotics (ie, antibiotics other than those used to treat C. difficile) during treatment for C. difficile infection has been shown to prolong the duration of symptoms and increase the risk of recurrence in adults [9,10]. In children, the use of concomitant antibiotics has been associated with recurrent disease [11]. If an ongoing infection requires continued antibiotic treatment, we suggest tailoring therapy to achieve the narrowest spectrum and shortest duration possible. (See "Clostridium difficile infection in children: Microbiology, pathogenesis, and epidemiology", section on 'Antibiotic exposure'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2017.
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