title: Fecal bacteriotherapy for relapsing Clostridium difficile infection in a child: a proposed treatment protocol.
abstract: Clostridium difficile infection (CDI) is a potentially serious emerging infectious disease. The incidences of CDI in childhood and CDI cases complicated by relapses have increased by 50% or more in North America during the past 2 decades. We report here the case of a 2-year-old child with relapsing CDI caused by the epidemic strain BI/NAP1/O27 that was refractory to Saccharomyces boulardii and Lactobacillus rhamnosus GG probiotics and to intensive therapy with traditional (metronidazole, vancomycin) and experimental (rifaximin, nitazoxanide) antibiotics despite its apparent antimicrobial-susceptible phenotype. After excluding other infectious causes of diarrhea and inflammatory bowel disease, we designed a protocol to safely administer fecal bacteriotherapy via a temporary nasogastric tube. We demonstrated for the first time that fecal transplantation is practical and effective for treating relapsing CDI in a young child. We recommend that this strategy be reserved for complicated cases of CDI that fail conventional therapy until randomized studies can confirm the safety and effectiveness of fecal bacteriotherapy in children.
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: George
authors.initials: G
authors.lastname: Russell
authors.forename: Jess
authors.initials: J
authors.lastname: Kaplan
authors.forename: Maryjane
authors.initials: M
authors.lastname: Ferraro
authors.forename: Ian C
authors.initials: IC
authors.lastname: Michelow
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000382:microbiology* / Q000628:therapy*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005243:Feces / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009324:Naturopathy / Q000379:methods*; D019936:Probiotics / Q000008:administration & dosage; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents