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Prospective study of toxigenic Clostridium difficile in children given amoxicillin/clavulanate for otitis media
D K Mitchell1, R Van, E H Mason
1Center for Pediatric Research, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
Insights
Antibiotic-associated diarrhea was evaluated in children treated with amoxicillin/clavulanate. Toxigenic Clostridium difficile was found in 13% of children post-therapy, especially those with diarrhea.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Pharmacology
Background:
- Antibiotic-associated diarrhea (AAD) is a common complication in children.
- Clostridium difficile infection (CDI) is a significant cause of AAD.
- Otitis media is frequently treated with amoxicillin/clavulanate in pediatric populations.
Purpose of the Study:
- To assess the prevalence of toxigenic Clostridium difficile in children receiving amoxicillin/clavulanate for otitis media.
- To determine the association between amoxicillin/clavulanate therapy and the presence of C. difficile toxins in pediatric stool samples.
Main Methods:
- Prospective study of children aged 12-47 months treated for otitis media.
- Stool specimen collection at enrollment, during diarrhea, and post-therapy (10 days).
- Enzyme immunoassay (EIA) for C. difficile toxins A and B detection.
Main Results:
- 76 children completed the study with paired stool samples.
- No C. difficile toxin detected at enrollment.
- Toxigenic C. difficile identified in 13% of children post-therapy (6/22 with diarrhea vs. 4/54 without diarrhea, P=0.03).
Conclusions:
- Toxigenic C. difficile is detected in pediatric patients after amoxicillin/clavulanate treatment for otitis media.
- The frequency of toxigenic C. difficile is significantly higher in children who develop diarrhea during therapy.
- This highlights the risk of C. difficile colonization and potential infection associated with amoxicillin/clavulanate use in children.
Objective:
Evaluate antibiotic-associated diarrhea and toxigenic Clostridium difficile in stool specimens obtained from children before and after 10 days of amoxicillin/clavulanate for otitis media.
Design:
Children, 12 to 47 months of age, treated with amoxicillin/clavulanate for otitis media in an outpatient setting were enrolled. Stool specimens were obtained at enrollment, when diarrhea occurred and at the end of therapy. All stool specimens were tested for C. difficile toxins A and B by enzyme immunoassay.
Results:
Seventy-six children who had stool specimens collected at enrollment and after therapy were included in the analysis. None had C. difficile toxin in stool specimens at enrollment. Six (27%) of 22 children with diarrhea, and 4 (7%) of 54 children without diarrhea had C. difficile toxin present at completion of therapy (P = 0.03).
Conclusion:
Toxigenic C. difficile was identified in 13% of children at the conclusion of amoxicillin/clavulanate therapy with a significantly higher frequency in children with diarrhea.