Table 5.
Comparison of prevention and treatment strategies for pediatric antibiotic-associated diarrhea vs adult antibiotic-associated diarrhea and pediatric Clostridium difficile infections vs adult Clostridium difficile infections
| Pediatric AAD | Ref. | Adult AAD | Ref. | Pediatric CDI | Ref. | Adult CDI | Ref. | |
| Prevention | ||||||||
| Enhanced infection control programs (% CDI reduced) | NR | NR | NR | 67% | You[219] | |||
| Antibiotic stewardship | NR | NR | NR | 46% | Wenisch[102] | |||
| (% CDI reduced) | 66% | Kallen[220] | ||||||
| Probiotics | S. boulardii (pRR = 0.43) | McFarland[19] | S. boulardii (pRR = 0.47) | McFarland[131] | S. boulardii (pRR = 0.25) | McFarland[138] | La+Lc+Lr (pRR = 0.21) | Johnson[137] |
| L. rhamnosus GG (pRR = 0.36) | McFarland[19] | S. boulardii (pRR = 0.49) | Szajewska[132] | S. boulardii (pRR = 0.25) | Szajewska[132] | La+Lc+Lr (pRR = 0.21) | McFarland[138] | |
| S. boulardii (pRR = 0.43) | Szajewska[132] | La+Lc+Lr (pRR = 0.51) | Hempel[129] | L. casei DN114001 (pRR = 0.08) | McFarland[138] | |||
| L. rhamnosus GG (pRR = 0.48) | Szajewska[132] | L. rhamnosus GG (no) | Szajewska[132] | S. boulardii (no) | Szajewska[132] | |||
| Treatment | ||||||||
| Initial episode1 | ||||||||
| No treatment given or stop inciting antibiotic (% done) | NR | 4% | Elseviers[37] | 0% | Khanna[40] | 10% | Vensteinsdottir[73] | |
| 4% | Kim[98] | |||||||
| 20% | Duleba[18] | 24% | McFarland[121] | |||||
| 53% | Pai[71] | 53% | Huang[65] | |||||
| 69% | Gogate[94] | |||||||
| Oral rehydration therapy (% cured) | 21% | Shan[93] | 17% | Elseviers[37] | NR | NR | ||
| Metronidazole | NR | NR | 31% | Gogat[94] | 75% | Vesteindottlir[73] | ||
| (% cured) | 69% | Morinville[100] | ||||||
| 82% | Khanna[40] | 84% | Zar[145] | |||||
| 90 | Pai[71] | 86% | Kim[221] | |||||
| 93% | Kim[98] | 94% | Wenisch[222] | |||||
| 97% | Duleba[18] | |||||||
| Vancomycin | NR | NR | 83% | Duleba[18] | 91% | Kim[221] | ||
| (% cured) | 85% | Jardin[206] | 94% | Cornely[141] | ||||
| 100% | Khanna[40] | 94% | Wenisch[222] | |||||
| 97% | Zar[145] | |||||||
| 100% | Vesteindottlir[73] | |||||||
| Severe disease (% cured) | NR | NR | NR | 97% vanco vs 76% metro | Zar[145] | |||
| Probiotics (% cured) | NR | S. boulardii (70%) | Ligny[140] | NR | S. boulardii (19%, ns) | McFarland[111] | ||
| Monoclonal antibodies | NR | NR | NR | 93% (P = 0.07) | Lowy[146] | |||
| (% cured) | ||||||||
| Recurrent disease1 | ||||||||
| Metronidazole | NR | NR | NR | 33% | Wullt[223] | |||
| (% no further recurrences) | 50% | Surawicz[142] | ||||||
| 58% | McFarland[143] | |||||||
| 80% | Vesteindottlir[73] | |||||||
| Vancomycin | NR | NR | NR | 46% (10 d) | McFarland[143] | |||
| (% no further recurrences) | 55% | Surawicz[142] | ||||||
| 69% (taper) | McFarland[143] | |||||||
| 86% (pulse) | McFarland[143] | |||||||
| 100% | Vesteindottlir[73] | |||||||
| Fidaxomycin | NR | NR | NR | 86% | Cornely[147] | |||
| (% no further recurrences) | ||||||||
| Probiotics | NR | NR | NR | S. boulardii (65%) | McFarland[111] | |||
| (% no further recurrences) | S. boulardii with high dose vanco (83%) | Surawicz[142] | ||||||
| Fecal replacement therapy | NR | NR | NR | 81% | van Nood[224] | |||
| (% no further recurrences) | 90% | Cammatora[225] |
1
Studies not reporting cure rates by initial or recurrent CDI cases were excluded. References are given by last name of first author and citation number in brackets. AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile infections; L.: Lactobacillus; La: L. acidophilus CL1285; Lc: L. casei LBC80R; Lr: L. rhamnosus CLR2; NR: Not reported; pRR: Pooled relative risk from meta-analysis; S.: Saccharomyces.