Clostridium difficile Colitis

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Metronidazole can be used for initial episodes and first recurrences of Clostridium difficile in children.

Either metronidazole or vancomycin are options for an initial cases and first recurrence of non-severe episode of Clostridium difficile colitis in children. Subsequent recurrent episodes and severe cases should be treated with oral vancomycin.

This is in contrast to adults where fidaxomicin or vancomycin are used first line in both initial and in recurrent cases. IV metronidazole is added for fulminant cases especially when ileus is present

Since publication of the guideline fidaxomicin has been approved for use in pediatrics.


McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):e1-e48. PMID: 29462280