Fidaxomicin Treatment of Clostridioides difficile Infections and Recurrences in Children and Adolescents: A Retrospective Multicenter Study

Máire A Conrad; Abby L Kaplan; Sarah Weinbrom; Silvia Nastasio; Diana Jo; Katie Conover; Kathleen Lo; Enju Liu; Melissa Crawford; Sonia Michail; Maribeth Nicholson; Suchitra K Hourigan; Judith R Kelsen; Stacy A Kahn

doi:10.1016/j.jpeds.2025.114681

Fidaxomicin Treatment of Clostridioides difficile Infections and Recurrences in Children and Adolescents: A Retrospective Multicenter Study

J Pediatr. 2025 Jun 6:285:114681. doi: 10.1016/j.jpeds.2025.114681. Online ahead of print.

Authors

Máire A Conrad¹, Abby L Kaplan², Sarah Weinbrom³, Silvia Nastasio⁴, Diana Jo⁵, Katie Conover⁶, Kathleen Lo⁷, Enju Liu⁸, Melissa Crawford⁹, Sonia Michail⁷, Maribeth Nicholson¹⁰, Suchitra K Hourigan¹¹, Judith R Kelsen⁹, Stacy A Kahn¹²

Affiliations

¹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: conradm@chop.edu.
² Inflammatory Bowel Disease Center, Boston Children's Hospital, Boston, MA.
³ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA.
⁴ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
⁵ Department of Pediatrics, Inova Fairfax Hospital, Falls Church, VA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's National Hospital, Washington, DC.
⁶ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
⁷ Division of Pediatric Gastroenterology, Children's Hospital of Los Angeles, and Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA.
⁸ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA.
⁹ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁰ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Division of Pediatric Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
¹¹ National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; Department of Pediatrics, Inova Fairfax Hospital, Falls Church, VA.
¹² Inflammatory Bowel Disease Center, Boston Children's Hospital, Boston, MA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.

PMID: 40482880
DOI: 10.1016/j.jpeds.2025.114681

Abstract

Objective: To report the effectiveness and tolerability of treating children with primary and recurrent Clostridioides difficile infection (CDI) with fidaxomicin in a real-world, multicenter cohort.

Study design: We performed a multicenter, retrospective, observational study of fidaxomicin treatment for primary or recurrent CDI in children ages 12 months to 18 years old identified from 2013 to 2021 at 5 centers via electronic medical records. Outcomes included assessment of clinical response at day 14 after initiation of fidaxomicin treatment and clinical and microbiologic outcomes at day 60 after initiation of fidaxomicin treatment in the initial responders.

Results: Of the 95 patients included in this study, 84 (88.4%) were treated with fidaxomicin for a recurrent CDI, and 82 (86.3%) had at least one medical or surgical comorbidity. At the completion of fidaxomicin treatment (ie, by day 14 after initiation), 50 patients (52.6%) had a clinical cure and an additional 29 (30.5%) had improvement of symptoms. Among 79 patients who responded to fidaxomicin treatment, 17 (21.5%) had a clinical and microbiologically confirmed recurrence of CDI by day 60, likely representing relapse. Patients with inflammatory bowel disease were less likely to achieve clinical cure at day 14 (OR 0.27 (95% CI 0.11, 0.70)), but 20 patients with inflammatory bowel disease who had initial clinical cure or response did not have a demonstrable increased risk of recurrence at day 60. The most common adverse events reported during therapy were abdominal pain and nausea.

Conclusions: In this retrospective, real-world study, fidaxomicin for children with CDI appears to be well tolerated and is associated with low rates of treatment failure.

Keywords: children; colitis; dysbiosis; fecal microbiota transplantation.