14
Treatment
Table 4. Recommendations for the Treatment of C. difficile
Infection (CDI) in Children
Clinical
Definition
Recommended
Treatment Pediatric Dose
Maximum
Dose
Strength,
Quality
Initial
episode,
non-severe
• Metronidazole
× 10 days (PO),
OR
• Vancomycin ×
10 days (PO)
• 7.5 mg/kg/dose
tid or qid
• 10 mg/kg/dose
qid
• 500 mg tid
or qid
• 125 mg qid
W-L
W-L
Initial
episode,
severe/
fulminant
• Vancomycin ×
10 days
(PO or PR),
WITH OR
WITHOUT
• Metronidazole
× 10 days (IV)
a
• 10 mg/kg/dose
qid
• 10 mg/kg/dose
tid
• 500 mg qid
• 500 mg tid
S-M
W-L
First
recurrence,
non-severe
• Metronidazole
× 10 days (PO),
OR
• Vancomycin ×
10 days (PO)
• 7.5 mg/kg/dose
tid or qid
• 10 mg/kg/dose
qid
• 500 mg tid
or qid
• 125 mg qid
W-L
Second or
subsequent
recurrence
• Vancomycin
in a tapered
and pulsed
regimen
b
,
OR
• Vancomycin for
10 days followed
by rifaximin
c
for
20 days,
OR
• Fecal microbiota
transplantation
• 10 mg/kg/dose
qid
• Vancomycin:
10 mg/kg/dose
qid; Rifaximin:
no pediatric
dosing
• —
• 125 mg qid
• Vancomycin:
500 mg qid;
Rifaximin:
400 mg tid
• —
W-L
W-L
W-VL
a
In cases of severe or fulminant CDI associated with critical illness, consider addition of intravenous
metronidazole to oral vancomycin.
b
Tapered and pulsed regimen as described in Table 2: Vancomycin 10 mg/kg with max of 125 mg
qid for 10–14 days, then 10 mg/kg with max of 125 mg bid for a week, then 10 mg/kg with max of
125 mg qd for a week, and then 10 mg/kg with max of 125 mg q2–3d for 2–8 weeks.
c
No pediatric dosing for rifaximin. Not approved by the US FDA for use in children <12 years
of age.
