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Antibiotic-associated pseudomembranous colitis in children
Insights
Antibiotic-associated pseudomembranous colitis in children is linked to Clostridium difficile. Oral vancomycin and cholestyramine effectively treated ten pediatric patients, demonstrating positive therapeutic outcomes.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antibiotic-associated pseudomembranous colitis (AAPC) is a significant concern in pediatric patients.
- The role of Clostridium difficile in pediatric AAPC requires further elucidation.
Purpose of the Study:
- To investigate the association of Clostridium difficile with AAPC in children.
- To evaluate the efficacy of therapeutic interventions for AAPC in pediatric cases.
Main Methods:
- Retrospective review of ten pediatric cases diagnosed with AAPC.
- Stool assays for cytopathic toxin and bacterial cultures for Clostridium difficile identification.
- Analysis of treatment responses to oral vancomycin and cholestyramine.
Main Results:
- All ten patients yielded a cytopathic toxin neutralized by Clostridium sordellii antitoxin.
- Clostridium difficile was identified in nine patients, producing a similar toxin.
- Oral vancomycin and cholestyramine demonstrated good therapeutic responses in treated patients.
Conclusions:
- Clostridium difficile is implicated as the causative agent in pediatric AAPC.
- Oral vancomycin and cholestyramine are effective treatment modalities for pediatric AAPC.
Abstract:
Ten cases of antibiotic-associated pseudomembranous colitis in children are reviewed. The ages ranged from 4 years to 17 years; the most frequently implicated antimicrobial agents were penicillins in six children and clindamycin in two. Stool assays showed specimens from all ten patients yielded a cytopathic toxin which was neutralized by Clostridium sordellii antitoxin with titers ranging from 1:40 to 1:40,000. Bacterial cultures of nine specimens uniformly yielded Clostridium difficile with a median concentration of 10(5.4) organisms per gram of wet weight. All nine isolates of C difficile showed a vitro production of a cytopathic toxin which was similar to or identical with that which was detected in the original stool specimen. All ten patients recovered. Six were treated with oral vancomycin and showed a good therapeutic response; one patient, however, suffered two relapses when treatment was discontinued, requiring a total of three courses of oral vancomycin. Two patients received cholestyramine and responded well. These observations provide supportive evidence that C difficile is responsible for antibiotic-associated pseudomembranous colitis in children and document efficacy of the newer therapeutic modalities in this patient population as well.