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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.

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