Diorio C, et al. - Researchers present a clinical practice guideline that was developed by them to provide clinicians with a guide on how to prevent and treat Clostridium difficile infection (CDI) in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT) patients. The guideline recommended against routine use of probiotics for preventing CDI, and against the routine use of monoclonal antibodies and probiotics to treat CDI. Either oral metronidazole or oral vancomycin for the initial treatment of nonsevere CDI; oral vancomycin for the initial treatment of severe CDI was strongly recommended.

Methods

• Researchers assembled an international multidisciplinary panel of experts in pediatric oncology and infectious diseases with patient advocate representation.
• They carried out systematic reviews of randomized controlled trials for the prevention or treatment of CDI in any population.
• They generated recommendations using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

• The use of either oral metronidazole or oral vancomycin for initial treatment of nonsevere CDI and oral vancomycin for initial treatment of severe CDI was strongly recommended by the panel.
• For recurrent CDI, fidaxomicin could be considered.
• According to the panel, probiotics should not be routinely used for the prevention of CDI, and monoclonal antibodies and probiotics should not be routinely used for the treatment of CDI.
• In this population, a strong recommendation to not use fecal microbiota transplantation was made.