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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3078-3104
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3078
Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections
Lynne Vernice McFarland, Metehan Ozen, Ener Cagri Dinleyici, Shan Goh
Lynne Vernice McFarland, Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA 98108-1597, United States
Metehan Ozen, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Disease, Atakent Acibadem University Hospital, Istanbul 34303, Turkey
Ener Cagri Dinleyici, Faculty of Medicine, Department of Pediatrics, Pediatric Intensive Care Unit, Eskisehir Osmangazi University, Eskisehir TR-26480, Turkey
Shan Goh, Department of Pathology and Pathogen Biology, Royal Veterinary College, Hertfordshire AL9 7TA, United Kingdom
Author contributions: McFarland LV designed the research question; all authors contributed to the literature search, analysis and writing the paper.
Conflict-of-interest statement: McFarland LV is a paid speaker for Biocodex and Lallemand and is a member of the Scientific Advisory Board for BioK+; Ozen M is a paid speaker for Menarini; Dinleyici EC is a member of Biocodex International Advisory Board; Goh S has no conflicts of interest; none of the authors owns stock or equity in companies discussed in paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lynne Vernice McFarland, PhD, Affiliate Associate Professor, Department of Medicinal Chemistry, School of Pharmacy, University of Washington, 1660 South Columbian Way, Puget Sound Health Care System, S-152 Seattle, WA 98108-1597, United States. lvmcfarl@u.washington.edu
Telephone: +1-206-2771780 Fax: +1-206-7631049
Received: December 16, 2015
Peer-review started: December 17, 2015
First decision: December 30, 2015
Revised: January 12, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: March 21, 2016
Abstract

Antibiotic-associated diarrhea (AAD) and Clostridum difficile infections (CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases PubMed (June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications (required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar (discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.

Keywords: Antibiotics, Antibiotic-associated diarrhea, Clostridum difficile infections, Adults, Pediatrics, Diarrhea, Risk factors, Treatments, Prevention

Core tip: Differences and similarities in clinical presentation and response to treatments were noted in pediatric and adult patients with regards to antibiotic-associated diarrhea and Clostridum difficile infections. Pediatric patients typically become symptomatic more rapidly, but also recover quicker than adults. While antibiotics are the major risk factor for both children and adult patients, adults have a more complex risk factor profile. Children respond best to metronidazole, while adults respond better to vancomycin. More studies are needed to characterize the disease process in antibiotic-associated diarrhea and treatment guidelines for pediatric patients.