Severe, complicated or fulminant C. difficile infection in children younger than 18 years

For the approach to managing severe, complicated or fulminant C. difficile infection, see Severe, complicated or fulminant Clostridioides difficile infection.

Note: Do not give vancomycin intravenously to treat C. difficile infection.

For severe C. difficile infection in children younger than 18 years, use:

vancomycin 10 mg/kg up to 125 mg orally or enterally, 6-hourly for 10 days¹ ² ³.vancomycin vancomycin vancomycin

For children with severe complicated C. difficile infection (eg hypotension or shock, ileus, toxic megacolon) or fulminant disease (rapidly progressing severe disease), start vancomycin as for severe C. difficile infection (see dosage above). Higher doses of vancomycin or concomitant intravenous metronidazole may be used in children with severe complicated or fulminant disease – seek expert advice urgently.

For children whose clinical condition fails to improve on the regimens above, seek expert advice.

For information about follow-up testing and patient education, see Follow-up for patients with Clostridioides difficile infection.

¹ Injectable vancomycin can be given orally or enterally, as an alternative to oral capsules. Dissolve 500 mg of vancomycin powder in 10 mL of water, measure the appropriate dose (eg 125 mg = 2.5 mL), and give orally or enterally. Flavouring syrups can be added before administration to improve palatability.Return

² Intravenous vancomycin is not effective against C. difficile infection because of inadequate penetration of the drug into the lumen of the colon.Return

³ Systemic absorption of vancomycin can occur with oral or enteral administration. If toxicity is suspected, consider measuring vancomycin plasma concentrations; otherwise, therapeutic drug monitoring is not required.Return