Volume 14 Supplement 7

Proceedings of the 10th Edition of the Scientific Days of the National Institute for Infectious Diseases "Prof Dr Matei Bals"

Open Access

Antibiotic treatment of Clostridium difficile infection in children – a challenge in pediatric practice

  • Gabriela Leşanu1,
  • Cristina Becheanu1,
  • Raluca Maria Vlad1Email author,
  • Daniela Lemeni2,
  • Ioana Sabina Macovei2,
  • Daniela Păcurar1,
  • Mirela Stocklosa1,
  • Irina Andronie1 and
  • Alexandra Moraru1
BMC Infectious Diseases201414(Suppl 7):P6

https://doi.org/10.1186/1471-2334-14-S7-P6

Published: 15 October 2014

Background

In the last decade the incidence of Clostridium difficile infection (CDI) in children is progressively increasing and the pediatricians are faced with difficulties in the therapeutic approach.

Methods

We performed a retrospective study that analyzed the antibacterial treatment in CDI from the experience of a Pediatric Gastroenterology Department – Grigore Alexandrescu Clinical Children’s Emergency Hospital, Bucharest. Cases were identified through enzyme immunoassays for A toxin or for A and B toxin of Clostridium difficile in the stool.

Results

Between January 1st 2005 and July 31st 2014, 52 patients were diagnosed with CDI. A large number of cases (61%) were diagnosed in the age group 1 to 4 years. The sex ratio was M/F = 0.9/1. 36% of patients had community-acquired CDI. In mild/moderate forms metronidazole was administered as a first-line treatment in 32 (61%) cases and proved efficient in 25/32 (78.1%) cases; vancomycin was used and was efficient in 18 cases. In severe forms (7.7%), the association of intravenous metronidazole and oral vancomycin was the option of choice and this approach cured all these cases. We report 11 patients with recurrent CDI (21%); in these cases oral vancomycin was efficient for the treatment of the recurrence. In 3 cases with a second recurrence rifaximin was the chosen therapy. Six out of 11 children with recurrent CDI had comorbidities (Hirschsprung disease, ulcerative colitis).

Conclusion

The majority of patients in the study group were 1 to 4 years aged children. One third of patients had community-acquired CDI. We consider that the failure rate for metronidazole treatment is small and thereby metronidazole may be recommended for the treatment of the first episode of mild/moderate CDI. The association of intravenous metronidazole and oral vancomycin remains the treatment of choice for severe cases.

Authors’ Affiliations

(1)
Grigore Alexandrescu Clinical Children’s Emergency Hospital
(2)
Cantacuzino National Institute for Research and Development for Microbiology and Immunology

Copyright

© Leşanu et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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