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A 5 month old comes in with diarrhea x 3 days, 5 times per day initially now 3 times per day, non-bloody, no fever, no vomiting. The patient was seen in the ED the day before, and had stool culture sent which was negative, C. difficile toxin which was positive, and stool WBC negative.
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June 5, 2018 at 9:29 am
Children under age 2 years have a high incidence of C. difficile carriage (37% for 0-1 month old, 30% for 1-6 months), which does not reach adult rates until 3 years of age. Testing for children younger than 12 months should only be performed in those with Hirschsprung or severe motility disorders and suspected disease. Testing in 1-3 year olds is difficult to interpret and should other causes for diarrhea should be ruled out first. A positive test after the third year of life is probably a true positive. In addition, per Harbor ID, testing should not be done unless the patient has at least 3 liquid bowel movements in the past 24 hours (in the absence of laxatives, enemas, or increased tube feeds), AND one or more of: fever > 38.5 C, WBC > 12,000, abdominal pain or tenderness. Donnatal should never be given to children, and probiotics are of unproven benefit, particularly since the patient is already improving.