FMT for Pediatric C. difficile Proves Effective

Fecal microbial transplant (FMT) is linked to excellent outcomes in recurrent cases of pediatric Clostridium difficile (C. difficile) infection, according to a new report.

Researchers from the University of British Columbia in Canada analyzed current trends in management and cure of pediatric C. difficile cases in order to provide an overview of the infection and treatment methods in that population.

The researchers explained that C. difficile is rare in children under the age of 2 years old, partially due to the lack of toxin-binding receptors in the infant gut. Another contributing factor is the presence of maternal antibodies, according to the researchers. Before the age of 1, C. difficile testing should be limited to outbreaks and those with high risk factors, according to the American Academy of Pediatrics. Between the ages of 1 and 3, testing can be considered if there has been recent antibiotic exposure and similar common causes can be ruled out.

A typical course of treatment in children’s C. difficile infection includes a 10 to 14-day course of oral metronidazole 30 mg/kg daily, plus stopping all other antibiotics during this time. In recurrent cases, oral vancomycin can be used for 10 to 14 days or on a tapered and pulsed regimen.

FMT has a high cure rate and potentially lower cost compared to other C. difficile therapies, the researchers explained. Specifically though, in children, such study results have not been published yet. In one case, FMT in a child resolved diarrhea and did not recur over six months of follow up. There have been 45 cases of FMT in children, according to the study authors, via various routes of delivery — 30 from colonoscopic and 15 from upper gastrointestinal tract administration.

The researchers acknowledged that FMT in children is still experimental, but because of the growing use in adults, there has been a push for standardization of donor materials. Donations for pediatric patients are primarily restricted to a family or household member. There are set regulations for storage and preparation of these materials. Some of the possible adverse effects include flatulence, rectal discomfort, nausea, vomiting, abdominal discomfort, bloating, headaches, and sore throats.

FMT is nearing a standard of treatment, the researchers wrote, but say that there are methods that can be used to decrease the risk of further recurrent cases. Plus, more early detection strategies — specifically for early relapses – would be an important diagnostic tool to develop. And finally, links between C. difficile infection and inflammatory bowel disorder should provide insights into possible FMT use in exacerbation in the future.

“More controlled studies in children are necessary, especially in children with other comorbidities such as IBD,” the study authors wrote. “The pediatric population presents as an ideal group for understanding the long term consequences and efficacy of repeat FMT in patients with relapses of C. difficile infection.”

The study, “Fecal microbiota transplantation for recurrent clostridium difficile infection in children,” was published online in the Journal of Infection.

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