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Policy statement provides management guidelines for children with C. difficile
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Interpreting positive test results for Clostridium difficile toxin in infants may be difficult because due to the high rate of asymptomatic colonization; therefore, routine testing of infants should be avoided and consideration for testing should be limited to those with severe gastrointestinal motility disorders or those in outbreak situations, according to a policy statement published online.
The policy statement, written by the AAP’s Committee on Infectious Diseases (COID), urges clinicians to seek alternative etiologies in the second and third years of life as well, because a positive result for C. difficile toxin in these age groups is not definitive.
The statement also addressed treatment: “Discontinuation of antimicrobial agents is the first step in treating C. difficile infection and may suffice in most instances. Antiperistaltic medications should be avoided.”
When antimicrobials are needed, the statement recommended metronidazole (30 mg/kg/day in four divided doses, orally; maximum, 2 g per day) as the drug of choice, and vancomycin for severe disease or the second recurrence.
Up to 30% of patients treated for C. difficile infection experience a recurrence after therapy is discontinued, according to the statement.
The committee also urged clinicians to use contact precautions with symptomatic patients, including hand washing.
Gordon E. Schutze
“The purpose of the AAP COID putting out this policy statement was to provide the practicing pediatrician with updated information about the issues relating to asymptomatic colonization, diagnosis of illness, and treatment of Clostridium difficile in children,” Gordon E. Schutze, MD, told Infectious Diseases in Children.
Disclosure: The researchers report no relevant financial disclosures.
Gordon E. Schutze, MD, can be reached at schutze@bcm.edu.
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