An insight into Clostridioides difficile-associated diarrhea in Saudi children: diagnosis and treatment

ABSTRACT

Introduction

Clostridioides difficile infection (CDI) is a major cause for antibiotic-associated diarrhea. Specific factors put the pediatrics at risk. International guidelines lists specific recommendations for the diagnosis and treatment of pediatric CDI. The practice of diagnosing and treating pediatric CDI in Saudi Arabia is slightly different from the recommendations of the guidelines.

Areas covered

This review summarizes pediatric CDI in Saudi Arabia in terms of epidemiology, current diagnostics, and how the practice compares to recommendations of the guidelines, and available treatment options.

Expert opinion

Although pediatric CDI epidemiology in Saudi Arabia doesn’t impose a burden on the healthcare system, it should be noted that not all hospitals follow CDI diagnostic recommendations of international guidelines, which may result in cases underreporting. However, due to the presumed low CDI prevalence, the traditional regimen of oral metronidazole for non-severe CDI remains effective, whereas vancomycin is used for severe cases. While fidaxomicin is approved for pediatrics, its high acquisition cost and low CDI rates make it challenging for hospitals to use it. Overall, pediatrics at risk of CDI recurrence should be evaluated, such as reviewing current antibiotics for potential discontinuation. Future studies evaluating the epidemiology and treatment for CDI in Saudi children are needed.

KEYWORDS:

• Clostridioides difficile
• Clostridium difficile
• diarrhea
• pediatric
• Saudi Arabia

Article highlights

• The overall epidemiology of Clostridioides difficile infection (CDI) in Saudi Arabia is low.

• Most hospitals in Saudi Arabia utilize nucleic acid-based testing for CDI diagnosis, followed by enzyme immunoassay for toxin detection.

• Due to the presumed low CDI prevalence in Saudi Arabia, oral metronidazole remains effective for non-severe CDI while vancomycin is recommended for severe cases.

• Fidaxomicin is reserved for fulminant cases not responding to traditional therapy due its high cost.

• Pediatric patients with certain risk factors should be evaluated for potential recurrence, such as receiving multiple antibiotic courses and immunosuppression.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.