A recent position paper (ZH Davidovics et al. JPGN 2019; 68: 130-43) from NASPGHAN/ESPGHAN on Fecal Microbioata Transplantation (FMT) for Recurrent Clostridium difficile infection (CDI) provides a pretty good review. Though, I think a summary table of recommendations would have made this publication much more helpful.
A couple key points/excerpts:
In general, we concur with current adult guidelines when considering FMT for the treatment of rCDI in children and propose FMT be considered in children with one of the following:
1. rCDI (recurrence of symptoms within 8 weeks of treatment for CDI) (either a or b)
a. At least 3 episodes of mild to moderate CDI and failure of a 6- to 8-week taper with vancomycin with or without an alternative antibiotic (eg, rifaximin, nitazoxanide).
b. At least 2 episodes of severe CDI resulting in hospitalization and associated with significant morbidity.
2. Moderate CDI not responding to standard therapy (including vancomycin) for at least 1 week. We recommend caution, however, in such cases, with repeated testing for etiologies other than CDI such as IBD.
3. Severe CDI or fulminant C difficile colitis with no response to standard therapy after 48 hours.
My take: I think the IDSA 2017 guidelines are more useful: Clostridium difficile Guidelines (2017 IDSA/SHEA)
More related blog posts:
- 4 Points for C diff in Inflammatory Bowel Disease
- Overdiagnosis of C difficile with PCR Assays
- C diff Risk factors in children
- Clostridium difficile/Fecal Microbiota Transplantation Video …
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