Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections

Table 5 Comparison of prevention and treatment strategies for pediatric antibiotic-associated diarrhea vs adult antibiotic-associated diarrhea and pediatric Clostridium difficile infections vs adult Clostridium difficile infections

	Pediatric AAD	Ref.	Adult AAD	Ref.	Pediatric CDI	Ref.	Adult CDI	Ref.
Prevention
Enhanced infection control programs (% CDI reduced)	NR		NR		NR		67%	You[219]
Antibiotic stewardship	NR		NR		NR		46%	Wenisch[102]
(% CDI reduced)							66%	Kallen[220]
Probiotics	S. boulardii (pRR = 0.43)	McFarland[19]	S. boulardii (pRR = 0.47)	McFarland[131]	S. boulardii (pRR = 0.25)	McFarland[138]	La+Lc+Lr (pRR = 0.21)	Johnson[137]
	L. rhamnosus GG (pRR = 0.36)	McFarland[19]	S. boulardii (pRR = 0.49)	Szajewska[132]	S. boulardii (pRR = 0.25)	Szajewska[132]	La+Lc+Lr (pRR = 0.21)	McFarland[138]
	S. boulardii (pRR = 0.43)	Szajewska[132]	La+Lc+Lr (pRR = 0.51)	Hempel[129]			L. casei DN114001 (pRR = 0.08)	McFarland[138]
	L. rhamnosus GG (pRR = 0.48)	Szajewska[132]	L. rhamnosus GG (no)	Szajewska[132]			S. boulardii (no)	Szajewska[132]
Treatment
Initial episode1
No treatment given or stop inciting antibiotic (% done)	NR		4%	Elseviers[37]	0%	Khanna[40]	10%	Vensteinsdottir[73]
					4%	Kim[98]
					20%	Duleba[18]	24%	McFarland[121]
					53%	Pai[71]	53%	Huang[65]
					69%	Gogate[94]
Oral rehydration therapy (% cured)	21%	Shan[93]	17%	Elseviers[37]	NR		NR
Metronidazole	NR		NR		31%	Gogat[94]	75%	Vesteindottlir[73]
(% cured)					69%	Morinville[100]
					82%	Khanna[40]	84%	Zar[145]
					90	Pai[71]	86%	Kim[221]
					93%	Kim[98]	94%	Wenisch[222]
					97%	Duleba[18]
Vancomycin	NR		NR		83%	Duleba[18]	91%	Kim[221]
(% cured)					85%	Jardin[206]	94%	Cornely[141]
					100%	Khanna[40]	94%	Wenisch[222]
							97%	Zar[145]
							100%	Vesteindottlir[73]
Severe disease (% cured)	NR		NR		NR		97% vanco vs 76% metro	Zar[145]
Probiotics (% cured)	NR		S. boulardii (70%)	Ligny[140]	NR		S. boulardii (19%, ns)	McFarland[111]
Monoclonal antibodies	NR		NR		NR		93% (P = 0.07)	Lowy[146]
(% cured)
Recurrent disease1
Metronidazole	NR		NR		NR		33%	Wullt[223]
(% no further recurrences)							50%	Surawicz[142]
							58%	McFarland[143]
							80%	Vesteindottlir[73]
Vancomycin	NR		NR		NR		46% (10 d)	McFarland[143]
(% no further recurrences)							55%	Surawicz[142]
							69% (taper)	McFarland[143]
							86% (pulse)	McFarland[143]
							100%	Vesteindottlir[73]
Fidaxomycin	NR		NR		NR		86%	Cornely[147]
(% no further recurrences)
Probiotics	NR		NR		NR		S. boulardii (65%)	McFarland[111]
(% no further recurrences)							S. boulardii with high dose vanco (83%)	Surawicz[142]
Fecal replacement therapy	NR		NR		NR		81%	van Nood[224]
(% no further recurrences)							90%	Cammatora[225]

¹Studies not reporting cure rates by initial or recurrent CDI cases were excluded. References are given by last name of first author and citation number in brackets. AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile infections; L.: Lactobacillus; La: L. acidophilus CL1285; Lc: L. casei LBC80R; Lr: L. rhamnosus CLR2; NR: Not reported; pRR: Pooled relative risk from meta-analysis; S.: Saccharomyces.