# Clostridioides difficile infection in children with cancer or after stem cell transplant

Source: https://onco.cc/protocols/paediatric-clostridioides-difficile/  
OnCo record `paediatric-clostridioides-difficile` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

C. difficile is a gut germ that can cause bad diarrhoea, often after antibiotics. In children having cancer treatment it is treated with an antibiotic by mouth, chosen by how severe it is. Children with it are kept apart from others to stop it spreading, and probiotics and faecal transplants are not used routinely during treatment.

## Summary

The 2024 update from an international panel led by the Pediatric Oncology Group of Ontario (96 randomised trials in any population, GRADE), endorsed by the Children's Oncology Group in August 2024, covers children and adolescents aged 1 to 18 with cancer or undergoing haematopoietic cell transplant; infants under 1 are excluded because C. difficile in them is usually colonisation. Treat non-severe infection with oral metronidazole or oral vancomycin (strong, low) and severe infection (colitis, pneumatosis, pseudomembranous colitis, ileus or surgery) with oral vancomycin or, new in 2024, oral fidaxomicin (strong, low), after a trial including children with cancer showed higher cure at follow-up and fewer recurrences with fidaxomicin. Consider fidaxomicin for recurrence (conditional, moderate). Do not use faecal microbiota transplantation routinely (strong, low), though it may be reasonable once treatment is over and the child is no longer immunosuppressed. Do not use probiotics routinely for prevention or treatment (conditional, low), because of documented invasive infections from probiotics in children with cancer, nor bezlotoxumab (conditional, moderate). Two new good practice statements: isolate according to local policy, and minimise systemic antibiotics, especially after a previous episode.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: C. difficile in children with cancer; C diff paediatric oncology; CDI children; Clostridium difficile children cancer
- Tags: protocol; paediatric; infection

## Connected records

- protocols: [Fever and neutropenia in children with cancer or after stem cell transplant](https://onco.cc/protocols/paediatric-fever-and-neutropenia/), [Hand hygiene in cancer care: staff, patients, families and visitors](https://onco.cc/protocols/hand-hygiene-in-cancer-care/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)

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