Metronidazole or Rifaximin for Treatment of Clostridium difficile in Pediatric Patients with Inflammatory Bowel Disease

Gawrońska, Agnieszka; Banasiuk, Marcin; Lachowicz, D; Pituch, Hanna; Albrecht, Piotr; Banaszkiewicz, Aleksandra

doi:10.1097/mib.0000000000001249

Cited by 15 publications

(5 citation statements)

References 36 publications

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“…In hospitalized IBD children with C difficile , 75% responded to metronidazole and the others responded to vancomycin (24). Similarly, a recent randomized controlled trial (RCT) of metronidazole versus rifaximin for treating C difficile in children with IBD (not with ASC) showed eradication rate of 71% versus 79%, respectively (49). A retrospective pediatric case series showed no difference in response rates between metronidazole (n = 15 (41%)) and vancomycin (n = 16 (43%)), but results were not stratified according to disease severity (28).…”

Section: Initial Managementmentioning

confidence: 99%

Management of Paediatric Ulcerative Colitis, Part 2

Turner

Ruemmele

Orlanski-Meyer

et al. 2018

J. pediatr. gastroenterol. nutr.

167

177

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Section: Initial Managementmentioning

confidence: 99%

Management of Paediatric Ulcerative Colitis, Part 2

Turner

Ruemmele

Orlanski-Meyer

et al. 2018

J. pediatr. gastroenterol. nutr.

167

177

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“…The cohort investigated in this study predominantly represented adolescent age ranges however, with relatively few (30/148) patients being under 2 years old. The antimicrobial rifaximin has shown similar efficacy to metronidazole for management of paediatric CDI, identifying it as a therapeutic option instead of metronidazole in inflammatory bowel disease patients [55]. Other novel therapeutics for paediatric CDI are under investigation, for example, the TcdB-neutralizing monoclonal antibody bezlotoxumab has recently been assessed for usage in paediatric cohorts [56].…”

Section: Managementmentioning

confidence: 99%

Clostridioides difficile detection and infection in children: are they just small adults?

Watkin,

Yongblah,

Burton

et al. 2024

Journal of Medical Microbiology

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Clostridioides difficile is a well-recognized healthcare-associated pathogen, with its significance widely recognized in adult populations. Despite this, there is limited data on the significance of detection within paediatric populations, both for individual patient management and wider transmission risk-based considerations. High rates of colonization are understood to occur in infants, with increasing levels up to 11 months, and colonization rates similar to adults by 8 years old. Sources of C. difficile are ubiquitous, with detection in companion animals and food sources, as well as within the clinical and wider environment. Due to the close interactions that occur between children and the environment, it is understandable that increasing recognition is afforded to the community acquisition of C. difficile in children. Other risk factors for the detection of C. difficile in children are similar to those observed in adults, including prior hospitalization and underlying conditions affecting gut health and motility. Recent studies have shown rising awareness of the role of asymptomatic carriage of C. difficile in healthcare transmission. Prior to this, paediatric patient populations were less likely to be screened due to uncertainty regarding the significance of detection; however, this increased awareness has led to a review of possible carriage testing pathways. Despite this increased attention, C. difficile infection remains poorly defined in paediatric populations, with limited dedicated paediatric data sets making comparison challenging. This is further complicated by the fact that infection in children frequently self resolves without additional therapies. Due to this, C. difficile remains a management challenge in paediatric settings.

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“…It is very suitable for the treatment of C. difficile and is a promising drug for the treatment of rCDI. [87][88][89] Theoretically, the solubility of rifaximin in bile is increased by 70-to 120-fold so that the effective concentration of rifaximin should be in the distal small intestine and proximal colon where C. difficile germinates. Rifaximin inhibits the proliferation of C. difficile, promotes the recovery of intestinal commensal bacteria, and restores the intestinal barrier.…”

Section: Rifaximinmentioning

confidence: 99%

Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management

Bai,

Guo,

Zheng

2023

Therap Adv Gastroenterol

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As a frequent complication of inflammatory bowel disease (IBD), Clostridium difficile infection (CDI) was confirmed to not only aggravate the symptoms of IBD but also result in unexpected outcomes, including death. With the increasing prevalence rate of IBD and the updating of CDI diagnosis, the incidence of CDI in IBD patients is also seen rising. Although a detection method consisting of glutamate dehydrogenase immunoassay or nucleic acid amplification test and then toxin A/B enzyme immunoassay was recommended and widely adopted, the diagnosis of CDI in IBD is still a challenge because of the overlap between the symptoms of CDI in IBD and CDI itself. Vancomycin and fidaxomicin are the first-line therapy for CDI in IBD; however, the treatment has different effects due to the complexity of IBD patients’ conditions and the choice of different treatment schemes. Although the use of fecal microbial transplantation is now in the ascendant for IBD management, the prospects are still uncertain and the prevention and treatment of the recurrence of CDI in IBD remain a clinical challenge. In this paper, the epidemiology, pathophysiology, clinical manifestation, prevention, and therapy of CDI in IBD were summarized and presented.

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Metronidazole or Rifaximin for Treatment of Clostridium difficile in Pediatric Patients with Inflammatory Bowel Disease

Abstract: Metronidazole and rifaximin were similarly effective treatments for CDI in pediatric patients with IBD.

Cited by 15 publications

References 36 publications

Management of Paediatric Ulcerative Colitis, Part 2

Management of Paediatric Ulcerative Colitis, Part 2

Clostridioides difficile detection and infection in children: are they just small adults?

Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management

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