Antibiotic-associated pseudomembranous colitis in children.
Ten cases of antibiotic-associated pseudomembranous colitis in children are reviewed. The ages ranged from 4 years to 17 years; the most frequently implicated antimicrobial agents were penicillins in six children and clindamycin in two. Stool assays showed specimens from all ten patients yielded a cytopathic toxin which was neutralized by Clostridium sordellii antitoxin with titers ranging from 1:40 to 1:40,000. Bacterial cultures of nine specimens uniformly yielded Clostridium difficile with a median concentration of 10(5.4) organisms per gram of wet weight. All nine isolates of C difficile showed a vitro production of a cytopathic toxin which was similar to or identical with that which was detected in the original stool specimen. All ten patients recovered. Six were treated with oral vancomycin and showed a good therapeutic response; one patient, however, suffered two relapses when treatment was discontinued, requiring a total of three courses of oral vancomycin. Two patients received cholestyramine and responded well. These observations provide supportive evidence that C difficile is responsible for antibiotic-associated pseudomembranous colitis in children and document efficacy of the newer therapeutic modalities in this patient population as well.
D000284:Administration, Oral; D000293:Adolescent; D000667:Ampicillin / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002792:Cholestyramine Resin / Q000627:therapeutic use; D002981:Clindamycin / Q000009:adverse effects; D003013:Clostridium / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology; D005243:Feces / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010400:Penicillin G / Q000009:adverse effects; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002792:Cholestyramine Resin; D002981:Clindamycin; D014640:Vancomycin; D000667:Ampicillin; D010400:Penicillin G