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

Table 1 Comparison of epidemiologic factors for pediatric antibiotic-associated diarrhea vs adult antibiotic-associated diarrhea and pediatric Clostridium difficile infections vs adult Clostridium difficile infections

Characteristics	Pediatric AAD rate/100 (n/total)	Ref.	Adult AAD rate/100 unless noted (n/total)	Ref.	Pediatric CDI rate/10000 (n/total)	Ref.	Adult CDI rate/10000 (n/total)	Ref.
Incidence:	29 (42/144)1	Shan[93]	7 (14/204)1	Duman[158]	22	Sathyendan[38]	4.3 pd3	Stevens[173]
Inpatient	80 (8/10)1	Jirapinyo[151]	9 (10/112)1	Selinger[112]	5.8 ad3	Chen[167]	5.4 py4	Vesteinsdottir[73]
			9.6 (67/743)2	Elseviers[37]	6.5 pd4	Kim[168]	5.7 hd2	Wenisch[102]
			10.4 (153/1471)1	Allen[159]	6.8 v3	Benson[70]	10 pd2	Hsu[103]
			13 (13/98)1	Pozzoni[160]	12.8 ad4	Zilberberg[5]	12 py5	Kuntz[174]
			15 (14/96)1	McFarland[96]	13.4 pd5	de Blank[69]	29.2 pd2	McFarland[121]
			19 (48/257)1	Li[161]	31.5 d4	Deshpande[169]	72 ad5	Zilberberg[7]
			22 (14/64)1	Surawicz[162]	135.0 ad3	Duleba[18]	1282	Huang[65]
			23 (55/242)2	Lusk[36]	416.71	Shan[93]	131 ad6	Jarvis[175]
			25 (41/167)1	Ouwehand[163]			1000 (93/30)1	Dietrich[23]
			29 (42/144)1	Shan[93]			2080 (83/399)2	McFarland[45]
			33 (10/30)1	Dietrich[23]
Outpatient	6.2 (14/225)2	Damrongmanne[76]	7.7/100000 py5	Hirschhorn[164]	143	Benson[70]	1.15	Fellmeth[75]
	11 (71/650)2	Turck[63]	12/100000 py2	Levy[165]	200 (1/58)1	Arvola[21]	1.22	Levy[165]
	16 (9/58)1	Arvola[21]	15/1005	Yapar[80]	390 (12/306)1	Boenning[170]	11.1 py5	Kuntz[174]
	24 (8/33)1	Ahmad[152]			780 (9/115)1	Hyams[171]
	26 (25/95)1	Vanderhoof[34]			790 (6/76)2	Mitchell[85]
	29 (22/76)2	Mitchell[85]
	52 (13/25)1	Saneeyan[153]
	59 (16/27)1	Seki[154]
	62 (31/50)1	La Rosa[155]
	75 (27/36)1	Fox[156]
Mixed in- and out-patients	17 (20/120)1	Ruszczyński[78]	2.5/100000 v2	Meropol[166]	1.45	Khanna[40]	2.5 py5	Khanna[17]
	23 (29/127)1	Kotowska[157]			2.14	Wendt[4]	5.42	Vesteinsdottir[73]
					60 (1/161)1	Destura[172]
					600 (7/120)1	Ruszczyński[78]
					800 (10/127)1	Kotowska[157]
Setting	NR		NR		25%	Khanna[40]	21%	Garg[178]
Health-care facility associated (HCFA) (% cases)					46%	Crews[12]	53%	Leung[179]
					48%	Sammons[44]	59%	Khanna[17]
					65%	Pai[71]	68%	Zilberberg[7]
					69%	Sandora[66]	89%	McFarland[45]
					71%	Tschudin-Sutter[72]	92%	Kazadova[180]
					74%	Schwartz[176]
Community-acquired (CA) (% cases)	NR		NR		19%	Tschudin-Sutter[72]	8%	Kazadova[180]
					25%	Sandora[66]	11%	McFarland[121]
					26%	Schwartz[176]	23%	Zilberberg[7]
					29%	Pai[71]	27%	Vesteinsdottir[73]
					30%	Samady[68]	33%	Garg[178]
					39%	Kociolek[177]	34%	Kutty[87]
					41%	Crews[12]	41%	Khanna[17]
					52%	Duleba[18]	43%	Leung[179]
					54%	Sammons[44]
					67%	Benson[70]
					71%	Wendt[4]
					75%	Khanna[40]
					96%	Søes[43]
Long term care facility acquired	NR		NR		NR	--	46%	Garg[178]
Age	18 (4-31) mo	Shan[93]	49 yr	Lusk[36]	1.5 yr	Shan[93]	59 yr	Stevens[173]
mean (range)	25 ± 9 mo	Mitchell[85]	72 yr	Elseviers[37]	2 yr	Khanna[40]	61 yr	El Feghaly[182]
	48 mo	Vanderhoof[34]			2 yr	Chen[167]	62 yr	Huang[65]
					2 yr	Duleba[18]	64 yr	Muto[59]
					3 yr	Pai[71]	64 yr	Kim[98]
					3 yr	Hart[54]	65 yr	Vesteinsdottir[73]
					3-6 yr	Kociolek[177]	66 yr	McFarland[121]
					4 yr	Kim[115]	68 yr	Khanna[17]
					5.4 yr	Morinville[100]	70 yr	McFarland[64]
					6 yr	Sammons[44]	71 yr	Garg[178]
					6.5 yr	Schwartz[176]	74 yr	Wenisch[102]
					6.5 yr	Wendt[4]	74 yr	Tabak[117]
					6.7 yr	Na[13]	75 yr	Loo[57]
					7 yr	Crews[12]	77 yr	Eyre[118]
					8 yr	Nylund[181]
					9 yr	Nylund[14]
					10 yr	Deshpande[169]
Gender	56%	Vanderhoof[34]	46%	Elseviers[37]	39%	Crews[12]	47%	Kim[98]
(% female)			48%	Lusk[36]	41%	Kociolek[177]	47%	Loo[57]
					42%	Schwartz[176]	47%	El Feghaly[182]
					46%	Hart[54]	49%	Carignan[183]
					46%	Khanna[40]	49%	Muto[59]
					46%	Kim[115]	49%	Stevens[173]
					46%	Morinville[100]	53%	Tabak[117]
					47%	Chen[167]	58%	Eyre[118]
					47%	Wendt[4]	63%	Garg[178]
					47%	de Blank[69]	64%	Huang[65]
					48%	Nylund[14]	64%	Wenisch[102]
					48%	Søes[43]	64%	Vesteinsdottir[73]
					49%	Sammons[44]	66%	Fellmeth[75]
					49%	Duleba[18]	66%	Crabtree[184]
					49%	Pai[71]	67%	Khanna[17]
					49%	Na[13]
Race:	NR		NR		59%	Sathyendan[38]	NR
Caucasian					65%	Sammons[44]
Outbreaks	n = 18	Kim[41]	NR		n = 6	Cartwright[48]	n = 6	See[185]
(number of cases)					n = 6	Ferroni[47]	n = 15	Lam[61]
					n = 13	Kim[41]	n = 21	Gaynes[55]
							n = 98-174	Johnson[56]
							n = 253	Muto[59]
							n = 293	Pépin[58]
							n = 1269	Jump[60]
							n = 1703	Loo[57]
Ribotype	NR		NR		0%	von Müller[51]	6.60%	Wenisch[102]
NAP1/027/BI prevalence					0%	Stoesser[52]	18%	Scardina[186]
					0%	Sathyendan[38]	28%	See[107]
					< 1%	Kociolek[177]	31%	Miller[62]
					< 1%	Søes[43]	31%	von Müller[51]
					11%	Schwartz[176]	50%	Toltzis[50]
					11%	Kim[98]
					19%	Toltzis[50]
					20%	Duleba[18]

¹Data from control group of randomized control trial;

²Data from prospective cohort study of hospital or community population;

³Data from retrospective review of limited number of hospitals;

⁴Data from population-based surveillance;

⁵Data from retrospective review of national database or several hospitals or population-based;

⁶Data from national point-prevalence survey. References are given by last name of first author and citation number in brackets. ad: Admissions; AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile infection; d: Discharges; hd: Hospital-days; NR: Not reported; pd: Patient-days; pop: Population; py: Person-years; v: Visits.

Table 2 Comparison of risk factors for pediatric antibiotic-associated diarrhea vs adult antibiotic-associated diarrhea and pediatric Clostridium difficile infections vs adult Clostridium difficile infections from multivariate analyses

Host Factors	Pediatric AAD	Ref.	Adult AAD	Ref.	Pediatric CDI	Ref.	Adult CDI	Ref.
Age	< 2 yr (RR = 1.8)	Turck[63]	> 70 yr	Elseviers[37]	1-4 yr	Tai[67]	> 65 yr	Hu[189]
			> 70 yr	Asha[22]	6 mo-2 yr	McFarland[1]	> 65 yr	Beaulieu[190]
							> 65 yr	Vardakas[74]
							> 65 yr	Pepin[106]
							> 65 yr	McFarland[89]
							> 85 yr	Vesteinsdottir[73]
							Yes (RR = 1.2)	Eyre[118]
							Yes (HR = 1.4)	Marwick[191]
Comorbidity	NR		No	Elseviers[37]	Yes (OR = 1.1)	Sammons[44]	Yes (OR = 1.3)	McFarland[121]
					Yes (OR = 1.1)	Tai[67]	Yes (OR = 4)	Wenisch[102]
					Yes (OR = 2.0)	Samady[68]	No	Tabak[117]
							No	Vesteinsdottir[73]
Chemotherapy	NR		No	Elseviers[37]	Yes (HR = 1.9)	de Blank[69]	Yes (OR =2.3)	Dubberke[192]
or cancer					Yes (OR = 3.8)	Tai[67]	Yes (OR = 3.6)	Huang[65]
					Yes (RR = 2.7)	Sathyendan[38]
IBD	NR		No	Elseviers[37]	Yes (OR = 11.4)	Hourigan[187]	Yes (OR = 3.3)	Hourigan[187]
					Yes (OR = 11.4)	Nyland[14]	No	Leung[179]
					Yes (OR = 4.5)	Kelsen[188]
Prior GI condition	NR		NR		NR		Yes (OR = 2.8)	McFarland[121]
Immuno-deficiency	NR		NR		Yes (OR = 6.0)	Samady[68]	NR
					Yes (OR = 8.1)	Sandora[66]
Disruptive factors
Previous antibiotics	NR		OR = 2.3	Elseviers[37]	Yes (OR = 1.2)	Sathyendan[38]	Yes (OR = 1.3)	Loo[57]
					Yes (OR = 2.2)	Sandora[66]	Yes (HR = 1.4)	Stevens[173]
							Yes (RR = 2.1)	McFarland[121]
					Yes (RR = 2.8)	Samady[68]	Yes (HR = 3.4)	Marwick[191]
							Yes (OR = 3.6)	Huang[65]
Type of antibiotic	Amoxicillin/clavulanate (RR = 2.4)	Turck[63]			Amino (HR = 1.3) and Ceph (HR = 2.4)	de Blank[69]	Clind (OR = 4.3) Ceph (RR = 3.8)	Johnson[56] Asha[22]
					Quino	Sandora[66]	Diclox, Clind,	Vesteinsdottir[73]
					(OR = 17.0)		Ceftriaxone
							(OR = 2.2-7.5)
							Ceph and Pen	McFarland[64]
							(OR = 2.1)
							Clind, Quino,	Loo[57]
							Ceph (OR = 3.8)
							Clind/Levo/Ceftrizone (OR = 3.0)	Muto[59]
							Cefoxitin (OR = 2.7)	Carignan[183]
							Ceph (OR = 5.6)	Dubberke[192]
							Quino (HR = 3.4)	Pépin[58]
No prior antibiotics < 2-8 wk prior	NR		NR		2%	Sammons[44]	6%	McFarland[64]
					5%	Duleba[18]	13%	Khanna[17]
					8%	Samady[68]	20%	McFarland[121]
					13%	Chen[167]	40%	Loo[57]
					19%	Crews[12]	96% (CO)	Fellmeth[75]
					22%	Khanna[40]
					27%	Pai[71]
					43% (CO)	Benson[70]
					67% (CO)	Wendt[4]
Abdominal surgery	NR		NR		Yes (OR = 3.3)	Sandora[66]	Yes (OR = 2.6)	Huang[65]
							Yes (OR = 2.8)	Zerey[193]
PPI	NR		OR = 2.0	Elseviers[37]	Yes (HR = 1.4)	de Blank[69]	Yes (OR = 1.6)	Dubberke[192]
			OR = 2.8	Asha[22]	Yes (RR= 1.7)	Sathyendan[38]	Yes (OR = 1.8)	Muto[59]
					Yes (RR = 2.4)	Nylund[181]	Yes (OR = 2.8)	Stevens[173]
					Yes (OR = 4.2)	Samady[68]	Yes (OR = 6.1)	Peled[25]
					No	Brown[194]	No	Khanna[17]
					No	Sandora[66]	No	Leung[179]
					No	Sammons[44]	No	Vesteinsdottir[73]
							No	Pépin[58]
							No	Marwick[191]
							No	Huang[65]
Histamine-2 receptor antagonist	NR		NR		Yes (RR = 2.2)	Brown[194]	Yes (OR = 3.1)	Peled[25]
Exposure to C. difficile spores
Prior hospitalization	NR		NR		Yes (OR = 1.7)	Tai[67]	Yes (OR = 1.3)	McFarland[121]
					Yes	Samady[68]	Yes (OR = 2.0)	Eyre[118]
					(OR = 2.3)		Yes (RR = 2.3)	Vesteinsdottir[73]
					No	Sandora[66]	Yes (HR = 4.7)	Marwick[191]
							Yes (RR = 5.1)	McFarland[64]
							No	Huang[65]
Prior long term care residence	NR		NR		NR		Yes (OR = 3.9)	Vesteinsdottir[73]
							Yes (HR = 4.1)	Marwick[191]
Prolonged length of stay (current)	NR		NR		Yes (OR = 15)	Tai[67]	Yes (RR = 1.01)	Asha[22]
							Yes (OR = 2.8)	Huang[65]
							Yes (OR = 5.1)	Lee[195]
							No	Carignan[183]
Infected roommates/CD proximity/CD pressure	NR		NR		NR		Yes (RR = 1.7)	McFarland[45]
							Yes (OR = 4.0)	Dubberke[192]
Previous CDI	NR		NR		NR		Yes (HR = 4.5)	Stevens[173]
							No	Khanna[17]

References are given by last name of first author and citation number in brackets. AAD: Antibiotic-associated diarrhea; Amino: Aminoglycoside; CDI: Clostridium difficile infections; IBD: Inflammatory bowel disease; Ceph: Cephalosporins; Clind: Clindamycin; CO: Community-onset; Diclox: Dicloxacillin; HR: Hazard ratio; Levo: Levofloxacin; NR: Not reported; OR: Odds ratio; Pen: Penicillin; PPI: Proton-pump inhibitor; RR: Relative risk; Quino: Quinolones.

Table 3 Comparison of clinical presentation for pediatric antibiotic-associated diarrhea vs adult antibiotic-associated diarrhea and pediatric Clostridium difficile infections vs adult Clostridium difficile infections

	Ped AAD	Ref.	Adult AAD	Ref.	Ped CDI	Ref.	Adult CDI	Ref.
Incubation period (mean days after antibiotic start or C. difficile positive)	2. 3 ± 1.1 d	Damrongmanee[76]	3.2 ± 2 d	Dietrich[23]	3 d	Mitchell[85]	2 d	McFarland[45]
	2.4 (1-8) d	Mitchell[85]	3.7 ± 2.6 d	Duman[158]	10 d	Pai[71]	6 d	Chang[86]
	4.0 ± 4.3 d	Corrêa[77]	7 d	Hickson[81]			10 d	James[197]
	4.9 ± 2.5 d	Shan[93]	8 d (1-30 d)	Lusk[36]			12 d	Figueroa[90]
	4.9 ± 3 d	Kotowska[157]	9 ± 1 d	Yapar[80]			13 d	Wenisch[102]
	5.3 ± 3.5 d	Turck[63]	16 d (6-60 d)	Pozzoni[160]
	6.2 ± 4.2 d	Ruszczyński[78]	18 d	McFarland[96]
Time of Onset (while on antibiotics vs delayed-onset post-antibiotic)	85% vs 15%	Turck[63]	26% vs 74%	Hickson[81]	80% vs 20%	Duleba[18]	23% vs 77%	Chang[86]
	92% vs 8%	Corrêa[77]	27% vs 73%	McFarland[96]
			38% vs 62%	Pozzoni[160]
			71% vs 29%	Can[79]
			75% vs 25%	Duman[158]
			85% vs 15%	Yapar[80]
Severity of disease
Duration	2.6 ± 1.1 d	Damrongmanee[76]	1-6 d	Allen[159]	2 d	Denno[97]	5.4 ± 1.8 d	Ouwehand[163]
(mean ± std. dev.) or median (range) days	3.9 ± 2.3 d	Destura[172]	2-25 d	McFarland[96]	2-9 d	McFarland[1]	6.6 d	Wenisch[102]
	4 ± 3 d	Turck[63]	3 (2-5) d	Pozzoni[160]	6 d	Crews[12]	13 ± 13 d	McFarland[89]
	4.1 ± 2.1 d	Ruszczyński[78]	4.4 ± 2.5 d	Dietrich[23]	7-8 d	Duleba[18]	13 ± 7.4 d	Morrow[198]
	5 ± 2.8 d	Corrêa[77]	4.9 ± 2 d	de Souza[139]			26 ± 56 d	Hsu[103]
	9 ± 1 d	Shan[93]	5.4 ± 1.8 d	Ouwehand[163]
			21.5 (1-72) d	Lusk[36]
Asymptomatic carriers	NR		NR		26%	Sandora[66]	6%	Jarvis[175]
					35%	Enoch[196]	9.4%	Bruns[199]
					45%	Rousseau[53]	9.7%	Leekha[200]
					67%	Delmée[49]	61%	McFarland[45]
Mild-moderate diarrhea	Most common		Most common		23%	Pai[71]	35%	McFarland[201]
					66%	Schwartz[176]	48%	Ramanathan[202]
					71%	Na[13]	59%	Jardin[206]
					72%	Wendt[4]	61%	Kyne[101]
					87%	Khanna[40]	61%	Bartlett[207]
Severe disease	Rare		16%	Gogate[94]	8%	Wendt[4]	3%	McFarland[201]
					12%	Khanna[40]	3%	Rubin[208]
					21%	Crews[12]	8%	Bartlett[207]
					27%	Schwartz[176]	9%	El Feghaly[182]
					76%	Pai[71]	16.4%	Pepin[106]
							18%	Wenisch[102]
							18%	See[185]
							34%	Khanna[209]
							47%	Jardin[206]
							52%	Ramanathan[202]
PMC	1 case	Vidrine[95]	1%	Lusk[36]	0.1%	Wendt[4]	0.1%	Wenisch[102]
					1.6%	Duleba[18]	1%	McFarland[201]
					4.9%	Kim[98]
Toxic megacolon	NR		NR		1 case	Castillo[99]	0.1%	Wenisch[102]
Fulminant disease	NR		NR		rare	Qualman[203]	2%	Dallal[108]
					n = 4	Rivlin[204]	4%	Sailhamer[210]
							6%	van de Wilden[211]
Recurrent disease	NR		28%	de Souza[139]	10%	Sandora[66]	18.8%	Wenisch[102]
					11%	Wendt[4]	21%	Vesteinsdottlir[73]
					16.5%	Crews[12]	22%	Eyre[118]
					17%	Nylund[181]	22%	Ramanathan[202]
					17%	Schwartz[176]	27%	McFarland[121]
					20%	Khanna[40]	29%	Wullt[122]
					22%	Nicholson[205]	29%	Khanna[17]
					24%	Kim[98]	36%	Drudy[212]
					31%	Morinville[100]	42%	McFarland[89]

References are given by last name of first author and citation number in brackets. AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile infections; NR: Not reported; PMC: Pseudomembraneous colitis.

Table 4 Comparison of consequences of 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.
Premature stop of antibiotic therapy	Yes	Damrongmanee[76]	4%	Elseviers[37]	NR		NR
Dehydration	NR		17%	Elseviers[37]	75%	Duleba[18]	NR
Attributable mortality	NR		NR		2%	Despandi[169]	5.7%	Dubberke[213]
					2.2%	Sammons[44]	5.7%	Gravel[119]
					3%	de Blank[69]	4.5%	Tabak[117]
							6.3%	Vesteinsdottir[73]
							6.9%	Loo[57]
							15%	McFarland[121]
							17%	Pépin[58]
Crude mortality	NR		3.6%	Selinger[112]	1%	Morinville[100]	10%	Tabak[117]
					2%	Nylund[14]	16.5%	Wenisch[102]
					3.8%	Kim[115]	28%	Bacci[120]
					4.6%	Crews[12]	35%	Eyre[118]
					5%	de Blank[69]	38%	Dubberke[213]
					5.4%	Pai[71]
Colectomy	NR		NR		0.1%	Wendt[4]	0.3%	See[107]
					0.9%	Despandi[169]	0.7%	Halabi[214]
					0.9%	Nylund[14]	1.2%	Dallal[108]
					1%	Pai[71]	2%	McFarland[121]
					1.2%	Kim[115]	6.2%	Muto[59]
							9.1%	Jarvis[175]
Cost	NR		$1400	Song[113]	$18900-$93000	Sammons[44]	$3103	McFarland[89]
($/patient)			$1968	Kamdeu[215]	$28404	Despande[169]	$3427-$33055	Kwon[10]
					$31957	Nylund[14]	$3427-99601	Dubberke[216]
							$7179	Dubberke[217]
							$116312	Dubberke[216]
							$113533	Lawrence[124]
							$23643	Tabak[117]
Length of stay (days additional stay)	NR		8.5 d	Elseviers[37]	4 d	Despande[169]	3 d	Lawrence[124]
					4 d	Nylund[14]	4 d	Dubberke[217]
					6 d	Sammons[44]	6 d	Vesteinsdottir[73]
					23d	de Blank[69]	10 d	Abdelsattar[218]
							13 d	Tabak[117]
							14 d	Crabtree[184]
							16 d	Zerey[193]
							24 d	McFarland[121]
Re-admissions	NR		8%	Pozzoni[160]	NR		21%	McFarland[121]
							39%	Abdelsattar[218]
							52%	Dubberke[213]

¹For initial CDI episodes only;

²For recurrent CDI episodes only;

³In intensive care unit. References are given by last name of first author and citation number in brackets. AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile infections; LOS: Length of stay; NR: Not reported.

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.