Management of Clostridium difficile Infection in Children and Adolescents With Cancer and Pediatric HSCT Recipients

As reported in the Journal of Clinical Oncology by Diorio et al, an international panel has released a clinical practice guideline on prevention and treatment of Clostridium difficile infection (CDI) in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT) recipients. The work represents the efforts of a multidisciplinary panel of experts in pediatric oncology and infectious diseases, with patient advocate representation as well.

Key Recommendations

The seven key recommendations of the panel are summarized/reproduced below:

  1. It is suggested that probiotics not be used routinely for the prevention of CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Weak recommendation]
  2. Either oral metronidazole or oral vancomycin should be used for the treatment of nonsevere CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Strong recommendation]
  3. Oral vancomycin should be used for the treatment of severe CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Strong recommendation]
  4. Fidaxomicin should be considered for the treatment of recurrent CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Weak recommendation]
  5. Fecal microbiota transplantation should not routinely be used for the treatment of CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Strong recommendation]
  6. It is suggested that monoclonal antibodies not be used routinely for the treatment of CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Weak recommendation]
  7. It is suggested that probiotics not be used routinely for the treatment of CDI in children and adolescents with cancer and pediatric patients undergoing HSCT. [Weak recommendation]

The panel concluded, “We present a guideline for the prevention and treatment of CDI in children and adolescents with cancer and [pediatric patients undergoing] HSCT. Future research should include randomized controlled trials that involve children with cancer and [pediatric patients undergoing] HSCT to improve the management of CDI in this population.”

The guideline was funded by the Pediatric Oncology Group of Ontario.

Lillian Sung, MD, PhD, of the Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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