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Metronidazole common CDI treatment for otherwise healthy children
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Mild Clostridium difficile infections in healthy children are often treated with metronidazole. However, optimal treatment in children with comorbidities or recurrent or severe disease is less clear, according to recent study findings published in the Journal of the Pediatric Infectious Diseases Society.
Members from a network of infectious diseases pediatricians were surveyed to determine the differences in management strategies for pediatric CDI based on clinical presentation or underlying comorbidities.
All participants reported using oral metronidazole for the treatment of mild CDI in otherwise healthy children, but metronidazole therapy was less frequently preferred (41% to 79%) for treating mild CDI in children with underlying comorbidities or immunosuppression. Sixty-five percent of participants preferred oral vancomycin alone or with another agent for management of severe CDI. However, more than 30% reported using only metronidazole alone for severe disease. Ninety-two percent of participants recommended either vancomycin alone or combined with another agent for a second recurrence of CDI, with 16% using a vancomycin taper.
Julia S. Sammons
“There is consensus among pediatric ID physicians in the management of mild CDI in healthy children, but management strategies vary for children with underlying comorbidities or recurrent or severe disease,” study researcher Julia S. Sammons, MD, MSCE, of The Children’s Hospital of Philadelphia, told Infectious Diseases in Children. “This variability in management signals a need for further research to determine the optimal management of pediatric CDI, particularly in special populations of children with underlying gastrointestinal disease or immunocompromising conditions. The finding that over 30% of respondents prefer metronidazole for management of severe CDI, in contrast to existing adult guidelines as well as recommendations from the AAP to use oral vancomycin in severe disease, signals an area where current pediatric practice might be improved.”
Julia S. Sammons, MD, MSCE, can be reached at sammonsj@email.chop.edu.
Disclosure: The study was funded in part by a cooperative agreement from the CDC. The researchers report no relevant financial disclosures.
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