TABLE 3.

Strengths and Limitations of Current C. difficile Therapies in Children

Therapeutic	Strengths	Limitations
Metronidazole	• Established experience	• Broad spectrum gut microbial activity with recurrence risk; • systemically absorbed; • neurotoxic with prolonged or repeated use
Vancomycin	• Established experience; • not systemically absorbed	• Broad spectrum gut microbial activity with recurrence risk; • promotes resistant pathogens such as vancomycin resistant enterococci
Fidaxomicin	• Narrow spectrum gut activity; • not systemically absorbed	• Limited experience with use in children; • expensive; • adverse effects of pyrexia, abdominal pain, emesis, diarrhea, constipation, elevation in liver enzyme activity and rash reported
Bezlotoxumab	• No systemic activity; • no affect on gut dysbiosis	• Insufficient data in children; • caution in those with congestive heart failure; • short-lived protection
Fecal microbiota transplantation	• May help to restore gut microbial dysbiosis	• Difficult to standardize; • no long term safety data on consequences of altering child microbiome yet available; • risk of transmission of donor derived infections or conditions