Journal article
Diagnosis and Management of Clostridium difficile Infection by Pediatric Infectious Diseases Physicians
Journal of the Pediatric Infectious Diseases Society, Vol.3(1), pp.43-48
01/01/2014
DOI: 10.1093/jpids/pit065
PMID: 26624906
Abstract
Background. The incidence of C difficile infection (CDI) has risen among children; however, optimal management of CDI within a diverse pediatric population remains unclear. Although adult guidelines recommend oral vancomycin for treatment of second recurrence or severe CDI, dedicated pediatric data to support pediatric specific management guidelines are lacking. Our objective was to describe current CDI management practices by pediatric infectious diseases (ID) physicians.
Methods. We surveyed pediatric members of the Emerging Infections Network, a network of infectious diseases (ID) physicians across North America, in October 2012. Clinical vignettes were used to determine how physicians modify CDI management based on clinical presentation or presence of comorbidities, including solid organ transplantation, inflammatory bowel disease, and neutropenia.
Results. Of the 285 physicians surveyed, 167 (59%) responded. There were no significant differences in geography, level of experience, or hospital type between respondents and non-respondents. All respondents (100%) used oral metronidazole for the initial occurrence of mild CDI in a normal host. Management varied substantially for mild CDI in patients with a variety of comorbidities, in whom metronidazole therapy was less frequently preferred (41-79%). For management of severe CDI, 65% preferred oral vancomycin alone or in combination with at least one other agent. For a second recurrence, oral vancomycin alone or in combination was preferred by 92%. Among 125 respondents who reported using alternative therapies for recurrent or severe CDI, 23 (18%) recommend fecal microbiota transplantation, while 20 (16%) reported using fidaxomicin.
Conclusions. Pediatric ID physicians prefer metronidazole for treatment of mild CDI in healthy children, but management strategies vary for patients with comorbidities or recurrent or severe disease. These findings highlight the need for pediatric comparative effectiveness studies aimed at determining the optimal treatment for pediatric CDI.
Details
- Title: Subtitle
- Diagnosis and Management of Clostridium difficile Infection by Pediatric Infectious Diseases Physicians
- Creators
- Julia Shaklee Sammons - University of PennsylvaniaJeffrey S. Gerber - University of PennsylvaniaPranita D. Tamma - Johns Hopkins UniversityThomas J. Sandora - Boston Children's HospitalSusan E. Beekmann - University of IowaPhilip M. Polgreen - Roy J. and Lucille A. Carver College of MedicineAdam L. Hersh - University of Utah
- Resource Type
- Journal article
- Publication Details
- Journal of the Pediatric Infectious Diseases Society, Vol.3(1), pp.43-48
- DOI
- 10.1093/jpids/pit065
- PMID
- 26624906
- NLM abbreviation
- J Pediatric Infect Dis Soc
- ISSN
- 2048-7193
- eISSN
- 2048-7207
- Publisher
- Oxford Univ Press
- Number of pages
- 6
- Grant note
- 1U50CK000187 / Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA
- Language
- English
- Date published
- 01/01/2014
- Academic Unit
- Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984359788602771
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