Title : A comparison of current treatments for clostridioides difficile infection in adults and children
Abstract:
Introduction: Clostridioides difficile infection (CDI) is one of the most common and severe causes of healthcare-associated diarrhea and is associated with substantial morbidity and mortality. Although CDI has traditionally posed a major clinical challenge in adult healthcare settings, the number of pediatric cases has increased considerably in recent years.
Aim: The aim of this study was to identify the most effective CDI treatments in adults and children and compare differences between the two groups.
Methods: We conducted a systematic review of studies published up to February 17, 2025, to compare therapies used for the treatment of CDI in pediatric and adult populations. The literature search covered the MEDLINE, EMBASE, and Cochrane Central databases.
Results: In the most recent meta-analysis in adults (27,959 patients; 49.2% women), fecal microbiota transplantation (FMT) was the most effective among 28 interventions, both for overall recovery and relapse prevention. FMT proved to be the most effective therapy in recurrent cases, while fidaxomicin proved to be the most effective in non-recurrent cases. Probiotics were not effective in preventing CDI, with no significant difference between probiotics and placebo (even in old age). Based on current guidelines, metronidazole, vancomycin, fidaxomicin and FMT can all be used reliably and effectively among children.
Conclusion: Based on our systematic review of adult cases, FMT has been shown to be highly effective in the treatment of recurrent CDI, confirming the potential for wider clinical application of FMT. In non-recurrent cases, antibiotics, specifically fidaxomicin and vancomycin, appear to be the primary treatment of choice. Overall, therapies used in the treatment of pediatric CDI show high and comparable cure rates, with no clear therapeutic advantage identified. Due to its higher concentration in stool, vancomycin appears to be the first-line treatment, while fidaxomicin and fecal microbiota transplantation may be promising alternatives, especially
in the treatment of recurrent cases.
Funding: Supported by the 2025-2.1.1-EKÖP-2025-00014 University Research Scholarship Programme of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.
