Clostridium difficile (peds) - Revision history

Ostermayer: Marked this version for translation

2026-01-07T12:32:37Z

Marked this version for translation

← Older revision		Revision as of 12:32, 7 January 2026
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	<languages/>		<languages/>
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			<!--T:1-->
	''This page is for <u>pediatric</u> patients; for adult patients see [[Special:MyLanguage/clostridium difficile\|clostridium difficile]].''		''This page is for <u>pediatric</u> patients; for adult patients see [[Special:MyLanguage/clostridium difficile\|clostridium difficile]].''

	==Background==		==Background== <!--T:2-->

			<!--T:3-->
	[[File:Pseudomembranous colitis 1.jpg\|thumb\|Pseudomembranous colitis with yellow pseudomembranes seen on the wall of the sigmoid colon.]]		[[File:Pseudomembranous colitis 1.jpg\|thumb\|Pseudomembranous colitis with yellow pseudomembranes seen on the wall of the sigmoid colon.]]
	*[[Special:MyLanguage/Clostridium\|Clostridium]] is a genus of [[Special:MyLanguage/Gram-positive bacteria\|Gram-positive bacteria]]		*[[Special:MyLanguage/Clostridium\|Clostridium]] is a genus of [[Special:MyLanguage/Gram-positive bacteria\|Gram-positive bacteria]]
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	===Pediatric Risk Factors===		===Pediatric Risk Factors=== <!--T:4-->

			<!--T:5-->
	*[[Special:MyLanguage/Antibiotic\|Antibiotic]] exposure, particularly [[Special:MyLanguage/penicillins\|penicillins]], [[Special:MyLanguage/cephalosporins\|cephalosporins]], [[Special:MyLanguage/clindamycin\|clindamycin]], [[Special:MyLanguage/fluoroquinolones\|fluoroquinolones]]		*[[Special:MyLanguage/Antibiotic\|Antibiotic]] exposure, particularly [[Special:MyLanguage/penicillins\|penicillins]], [[Special:MyLanguage/cephalosporins\|cephalosporins]], [[Special:MyLanguage/clindamycin\|clindamycin]], [[Special:MyLanguage/fluoroquinolones\|fluoroquinolones]]
	*[[Special:MyLanguage/PPIs\|PPIs]]		*[[Special:MyLanguage/PPIs\|PPIs]]
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	==Clinical Features==		==Clinical Features== <!--T:6-->

			<!--T:7-->
	''Varies according to severity and intrinsic host factors (immunosuppression, etc.).''		''Varies according to severity and intrinsic host factors (immunosuppression, etc.).''
	*[[Special:MyLanguage/Diarrhea\|Diarrhea]] that develops during antibiotic use or within 2 weeks of discontinuation		*[[Special:MyLanguage/Diarrhea\|Diarrhea]] that develops during antibiotic use or within 2 weeks of discontinuation
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:8-->

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	==Evaluation==		==Evaluation== <!--T:9-->

			<!--T:10-->
	[[File:MPX1834 synpic40781.png\|thumb\|Pseudomembranous colitis from ''C. difficile'' on abdominal CT demonstratin diffuse colonic wall thickening and a shaggy endoluminal contour.]]		[[File:MPX1834 synpic40781.png\|thumb\|Pseudomembranous colitis from ''C. difficile'' on abdominal CT demonstratin diffuse colonic wall thickening and a shaggy endoluminal contour.]]
	[[File:PMC5137169 gr1.png\|thumb\|Pseudomembranous colitis with (A) Accordion sign in transverse colon (thin arrows). (B) Colonic wall thickness, target sign (thick arrow), peritoneal fluid (thin arrow) and pericolonic fat stranding (arrowhead).]]		[[File:PMC5137169 gr1.png\|thumb\|Pseudomembranous colitis with (A) Accordion sign in transverse colon (thin arrows). (B) Colonic wall thickness, target sign (thick arrow), peritoneal fluid (thin arrow) and pericolonic fat stranding (arrowhead).]]

	===Labs===		===Labs=== <!--T:11-->

			<!--T:12-->
	*C. diff toxin assay		*C. diff toxin assay
	**Sn 63-94%, Sp 75-100%		**Sn 63-94%, Sp 75-100%
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	===Testing Algorithm===		===Testing Algorithm=== <!--T:13-->

			<!--T:14-->
	''For patients with suspected Clostridium difficile associated diarrhea (CDAD)''		''For patients with suspected Clostridium difficile associated diarrhea (CDAD)''
	*'''Low''' suspicion		*'''Low''' suspicion
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	===Repeat testing===		===Repeat testing=== <!--T:15-->

			<!--T:16-->
	*Never a need for repeat testing within 7 days of a previous test		*Never a need for repeat testing within 7 days of a previous test
	*NO NEED to repeat positive tests as symptoms resolve as a “test of cure”		*NO NEED to repeat positive tests as symptoms resolve as a “test of cure”
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	===Pediatrics===		===Pediatrics=== <!--T:17-->

			<!--T:18-->
	*Testing in infants < 1 year of age not recommended due to high rates of colonization		*Testing in infants < 1 year of age not recommended due to high rates of colonization
	**~40% of infants < 1 month are colonized and asymptomatic<ref>Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. Jangi S, Lamont JT. J Pediatr Gastroenterol Nutr. 2010 Jul; 51(1):2-7.</ref>		**~40% of infants < 1 month are colonized and asymptomatic<ref>Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. Jangi S, Lamont JT. J Pediatr Gastroenterol Nutr. 2010 Jul; 51(1):2-7.</ref>
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	==Management==		==Management== <!--T:19-->

			<!--T:20-->
	*Stop offending antimicrobial agents, if possible		*Stop offending antimicrobial agents, if possible
	*Initial occurrence and first recurrence of mild-moderate disease:<ref>D'Ostroph AR and So TY. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist. 2017; 10: 365–375.</ref>		*Initial occurrence and first recurrence of mild-moderate disease:<ref>D'Ostroph AR and So TY. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist. 2017; 10: 365–375.</ref>
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	==Disposition==		==Disposition== <!--T:21-->

			<!--T:22-->
	*Admit:		*Admit:
	**Severe [[Special:MyLanguage/diarrhea\|diarrhea]]		**Severe [[Special:MyLanguage/diarrhea\|diarrhea]]
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	==[[Special:MyLanguage/Antibiotic Sensitivities\|Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==		==[[Special:MyLanguage/Antibiotic Sensitivities\|Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== <!--T:23-->

			<!--T:24-->
	{\| class="wikitable"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''Category'''		\| align="center" style="background:#f0f0f0;"\|'''Category'''
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	==See Also==		==See Also== <!--T:25-->

			<!--T:26-->
	*[[Special:MyLanguage/Diarrhea\|Diarrhea]]		*[[Special:MyLanguage/Diarrhea\|Diarrhea]]
	*[[Special:MyLanguage/Clostridium\|Clostridium]]		*[[Special:MyLanguage/Clostridium\|Clostridium]]


	==References==		==References== <!--T:27-->

			<!--T:28-->
	<references/>		<references/>

			<!--T:29-->
	[[Category:ID]]		[[Category:ID]]
	[[Category:GI]]		[[Category:GI]]
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Ostermayer: Prepared the page for translation

2026-01-04T21:54:20Z

Prepared the page for translation

Show changes

Rossdonaldson1: /* Disposition */

2023-02-01T21:46:26Z

Disposition

← Older revision		Revision as of 21:46, 1 February 2023
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	==Disposition==		==Disposition==
	*Admit:		*Admit:
	**Severe diarrhea		**Severe [[diarrhea]]
	**Outpatient antibiotic failure		**Outpatient antibiotic failure
	**Systemic response (fever, leukocytosis, severe abdominal pain)		**Systemic response ([[fever]], [[leukocytosis]], severe [[abdominal pain]])


	==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==		==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==

ClaireLewis at 19:59, 29 September 2019

2019-09-29T19:59:58Z

← Older revision		Revision as of 19:59, 29 September 2019
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	===Pediatric Risk Factors===		===Pediatric Risk Factors===
	*Antibiotic exposure, particularly [[penicillins]], [[cephalosporins]], [[clindamycin]], [[fluoroquinolones]]		*[[Antibiotic]] exposure, particularly [[penicillins]], [[cephalosporins]], [[clindamycin]], [[fluoroquinolones]]
	*[[PPIs]]		*[[PPIs]]
	*GI feeding tubes		*GI feeding tubes
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	==Clinical Features==		==Clinical Features==
	~~===History===~~		''Varies according to severity and intrinsic host factors (immunosuppression, etc.).''
	*[[Diarrhea]] that develops during antibiotic use or within 2 weeks of discontinuation		*[[Diarrhea]] that develops during antibiotic use or within 2 weeks of discontinuation
	*Usually occurs after 7-10 days of antibiotics, as diarrhea before that time is more often poor tolerance to antibiotic		*Usually occurs after 7-10 days of antibiotics, as diarrhea before that time is more often poor tolerance to antibiotic
	*Recent discharge from hospital		*Recent discharge from hospital
	*Profuse watery diarrhea		*Profuse watery diarrhea
			*[[Abdominal pain]]/tenderness
	~~===Exam===~~
	*[[Abdominal pain]]
	*[[Fever]]		*[[Fever]]
			*At the extreme, may present with [[sepsis]] secondary to intestinal perforation or [[toxic megacolon]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Management */

2019-07-04T03:23:37Z

Management

← Older revision		Revision as of 03:23, 4 July 2019
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	*Severe infection or second recurrence:		*Severe infection or second recurrence:
	**PO [[vancomycin]] 40 mg/kg/d in four divided doses, max 500 mg/day		**PO [[vancomycin]] 40 mg/kg/d in four divided doses, max 500 mg/day
	**If no improvement after 24-48 hours, oral vancomycin max dose may be increased to 2 g/d		**If no improvement after 24-48 hours, oral [[vancomycin]] max dose may be increased to 2 g/d
	**Q6hr IV [[metronidazole]], 30 mg/kg/d, may be added to intracolonic/enema [[vancomycin]] for ileus, inability to tolerate PO antibiotics		**Q6hr IV [[metronidazole]], 30 mg/kg/d, may be added to intracolonic/enema [[vancomycin]] for ileus, inability to tolerate PO antibiotics
	***1-3 year old -- 250 mg vancomycin in 50 mL NS		***1-3 year old -- 250 mg [[vancomycin]] in 50 mL NS
	***4-9 year old -- 375 mg vancomycin in 75 mL NS		***4-9 year old -- 375 mg [[vancomycin]] in 75 mL NS
	***> 9 year old -- 500 mg vancomycin in 100 mL NS		***> 9 year old -- 500 mg [[vancomycin]] in 100 mL NS
	*Multiple recurrences, other strategies, in consult with pediatric GI:		*Multiple recurrences, other strategies, in consult with pediatric GI:
	**May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults		**May benefit from tapering and pulse oral [[vancomycin]] over 1.5-2 months, as done in adults
	**Consider PO [[fidaxomicin]] in ≥ 6 year old patients at 200 mg twice daily for 10 dats		**Consider PO [[fidaxomicin]] in ≥ 6 year old patients at 200 mg twice daily for 10 dats

Rossdonaldson1: /* Management */

2019-07-04T03:23:03Z

Management

Rossdonaldson1: /* Antibiotic SensitivitiesSanford Guide to Antimicrobial Therapy 2014 */

2019-07-04T03:21:13Z

Antibiotic SensitivitiesSanford Guide to Antimicrobial Therapy 2014

← Older revision		Revision as of 03:21, 4 July 2019
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	===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>===		==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
	{\| class="wikitable"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''Category'''		\| align="center" style="background:#f0f0f0;"\|'''Category'''

Rossdonaldson1 at 03:20, 4 July 2019

2019-07-04T03:20:58Z

@@ Line 7: / Line 7: @@
 *Alcohol-based hand sanitizers do not reduce spores, but good hand washing does<ref>Leffler DA and Lamont JT. Clostridium difficile Infection. N Engl J Med. 2015; 372:1539-1548.</ref>
-===Risk factors (pseudomembranous colitis)===
+===Pediatric Risk Factors===
-*Recent antibiotic use (any)
+*Antibiotic exposure, particularly [[penicillins]], [[cephalosporins]], [[clindamycin]], [[fluoroquinolones]]
-*GI surgery
+*[[PPIs]]
-*Severe underlying medical illness
+*GI feeding tubes
-*Chemo
+*Comorbidities - cancer, recent surgery, hospitalizations
 ==Clinical Features==
@@ Line 63: / Line 51: @@
 *NO NEED to repeat positive tests as symptoms resolve as a “test of cure”
 *NO NEED to repeat test soon after initial negative test (more likely to be a false positive test than a true positive test)
 ==Management==
 *Stop offending antimicrobial agents, if possible
 *Initial occurrence and first recurrence of mild-moderate disease:<ref>D'Ostroph AR and So TY. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist. 2017; 10: 365–375.</ref>
@@ Line 117: / Line 72: @@
 **May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults
 **Consider PO fidaxomicin in ≥ 6 year old patients at 200 mg twice daily for 10 dats
 ===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>===
@@ Line 260: / Line 222: @@
 | ||[[Colistimethate]]||X1
 |}
 ==See Also==

Rossdonaldson1 at 03:08, 4 July 2019

2019-07-04T03:08:50Z

Show changes

Rossdonaldson1: Created page with "''This page is for pediatric patients; for adult patients see clostridium difficile.''"

2019-07-04T03:08:29Z

Created page with "''This page is for <u>pediatric</u> patients; for adult patients see clostridium difficile.''"

New page

''This page is for <u>pediatric</u> patients; for adult patients see [[clostridium difficile]].''

← Older revision		Revision as of 03:23, 4 July 2019
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	*Stop offending antimicrobial agents, if possible		*Stop offending antimicrobial agents, if possible
	*Initial occurrence and first recurrence of mild-moderate disease:<ref>D'Ostroph AR and So TY. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist. 2017; 10: 365–375.</ref>		*Initial occurrence and first recurrence of mild-moderate disease:<ref>D'Ostroph AR and So TY. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist. 2017; 10: 365–375.</ref>
	**PO metronidazole 30 mg/kg/d in four divided doses, max 2 g/day		**PO [[metronidazole]] 30 mg/kg/d in four divided doses, max 2 g/day
	*Severe infection or second recurrence:		*Severe infection or second recurrence:
	**PO vancomycin 40 mg/kg/d in four divided doses, max 500 mg/day		**PO [[vancomycin]] 40 mg/kg/d in four divided doses, max 500 mg/day
	**If no improvement after 24-48 hours, oral vancomycin max dose may be increased to 2 g/d		**If no improvement after 24-48 hours, oral vancomycin max dose may be increased to 2 g/d
	**Q6hr IV metronidazole, 30 mg/kg/d, may be added to intracolonic/enema vancomycin for ileus, inability to tolerate PO antibiotics		**Q6hr IV [[metronidazole]], 30 mg/kg/d, may be added to intracolonic/enema [[vancomycin]] for ileus, inability to tolerate PO antibiotics
	***1-3 year old -- 250 mg vancomycin in 50 mL NS		***1-3 year old -- 250 mg vancomycin in 50 mL NS
	***4-9 year old -- 375 mg vancomycin in 75 mL NS		***4-9 year old -- 375 mg vancomycin in 75 mL NS
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	*Multiple recurrences, other strategies, in consult with pediatric GI:		*Multiple recurrences, other strategies, in consult with pediatric GI:
	**May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults		**May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults
	**Consider PO fidaxomicin in ≥ 6 year old patients at 200 mg twice daily for 10 dats		**Consider PO [[fidaxomicin]] in ≥ 6 year old patients at 200 mg twice daily for 10 dats

	==Disposition==		==Disposition==