Clostridium difficile (peds)

Pseudomembranous colitis with yellow pseudomembranes seen on the wall of the sigmoid colon.

• Clostridium is a genus of Gram-positive bacteria
• Most common cause of infectious diarrhea in hospitalized patients
• Use contact isolation if suspect
• Alcohol-based hand sanitizers do not reduce spores, but good hand washing does[1]

Varies according to severity and intrinsic host factors (immunosuppression, etc.).

• 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
• Recent discharge from hospital
• Profuse watery diarrhea
• Abdominal pain/tenderness
• Fever
• At the extreme, may present with sepsis secondary to intestinal perforation or toxic megacolon

• Stop offending antimicrobial agents, if possible
• Initial occurrence and first recurrence of mild-moderate disease:[5]
  • PO metronidazole 30 mg/kg/d in four divided doses, max 2 g/day
• Severe infection or second recurrence:
  • 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
  • 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
    • 4-9 year old -- 375 mg vancomycin in 75 mL NS
    • > 9 year old -- 500 mg vancomycin in 100 mL NS
• 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
  • Consider PO fidaxomicin in ≥ 6 year old patients at 200 mg twice daily for 10 dats

• Admit:
  • Severe diarrhea
  • Outpatient antibiotic failure
  • Systemic response (fever, leukocytosis, severe abdominal pain)

• Diarrhea
• Clostridium