Optimal therapeutic recommendation for Clostridioides difficile infection in pediatric and adolescent populations: a systematic review and meta-analysis

Sho Tashiro, Takayuki Mihara, Rikiya Okawa, Yoko Tanaka, Masaru Samura, Yuki Enoki, Kazuaki Taguchi, Kazuaki Matsumoto, Yuka Yamagishi

Research output: Contribution to journalArticlepeer-review

Abstract

We conducted a systematic review and meta-analysis to examine the efficacy profiles of metronidazole (MNZ) and vancomycin (VCM) in pediatric and adolescent patients with Clostridioides difficile infection (CDI). A systematic review and meta-analysis was conducted using four electronic databases (PubMed, Cochrane Library, Web of Science, and Clinicaltrials.gov) through July 6, 2022. We analyzed the clinical cure and recurrence rates to determine the efficacy of MNZ and VCM. The clinical cure rates in all included studies were not significantly different between MNZ and VCM (OR = 0.63; 95% CI = 0.36–1.10; I2 = 0%; P = 0.10). Subgroup analyses were performed separately for each region to account for regional differences in the CDI. MNZ treatment achieved significantly lower clinical cure rates than did VCM in the United States of America (USA) and Europe (OR = 0.42, 95% CI = 0.19–0.93, I2 = 0%, P = 0.03). Recurrence rates were not significantly different between MNZ and VCM (OR = 1.48, 95% CI = 0.62–3.53, I2 = 28%, P = 0.38). Conclusion: MNZ exhibited significantly lower clinical cure rates than did VCM in the US and Europe; therefore, it is not recommended for the management of CDI in pediatric and adolescent populations.What is Known:• The unavailability of robust data on recommendations of therapeutic agents for the management of Clostridioides difficile infections in children precludes effective antibiotic choice.What is New:• Metronidazole exhibited significantly lower clinical cure rates than did vancomycin in the United States of America and Europe and recurrence rate was not significantly different between metronidazole and vancomycin; therefore, it is not recommended for the management of Clostridioides difficile infection in children.

Original languageEnglish
Pages (from-to)2673-2681
Number of pages9
JournalEuropean Journal of Pediatrics
Volume182
Issue number6
DOIs
Publication statusPublished - 2023 Jun

Keywords

  • Clostridioides difficile infection
  • Metronidazole
  • Pediatric and adolescent populations
  • Systematic review and meta-analysis
  • Vancomycin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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