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Fidaxomicin Treatment of Clostridioides difficile Infections and Recurrences in Children and Adolescents: A

Máire A Conrad1, Abby L Kaplan2, Sarah Weinbrom3

  • 1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

The Journal of Pediatrics
|June 7, 2025
PubMed

Insights

Fidaxomicin effectively treats children with Clostridioides difficile infection (CDI), showing good tolerability and low failure rates in a real-world setting. This study highlights its potential for managing both primary and recurrent CDI in pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Clinical Pharmacology

Background:

  • Clostridioides difficile infection (CDI) poses a significant challenge in pediatric populations, with increasing rates of recurrence.
  • Limited real-world data exists on the effectiveness and tolerability of fidaxomicin in children with CDI.

Purpose of the Study:

  • To evaluate the real-world effectiveness and tolerability of fidaxomicin in treating primary and recurrent CDI in children.
  • To assess clinical and microbiologic outcomes in pediatric patients receiving fidaxomicin.

Main Methods:

  • A multicenter, retrospective, observational study was conducted involving children aged 12 months to 18 years treated with fidaxomicin for CDI between 2013 and 2021.
  • Clinical response was assessed at day 14, and clinical and microbiologic outcomes were evaluated at day 60 post-treatment initiation in initial responders.

Main Results:

  • Of 95 pediatric patients, 88.4% had recurrent CDI and 86.3% had comorbidities. Clinical cure or improvement was observed in 83.1% by day 14.
  • Among initial responders, 21.5% experienced clinical and microbiologic recurrence by day 60.
  • Patients with inflammatory bowel disease showed lower initial cure rates but no increased risk of later recurrence. Abdominal pain and nausea were the most common adverse events.

Conclusions:

  • Fidaxomicin is well-tolerated and demonstrates a low rate of treatment failure in children with CDI in a real-world setting.
  • The drug shows promise for managing both primary and recurrent CDI in pediatric patients, including those with comorbidities.
Abstract

Keywords:
childrencolitisdysbiosisfecal microbiota transplantation

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