Stop offending antimicrobial agents, if possible
Initial occurrence and first recurrence of mild-moderate disease:
PO metronidazole 30 mg/kg/d in four divided doses, max 2 g/day
Severe infection or second recurrence:
PO vancomycin 40 mg/kg/d in four divided doses, max 500 mg/day
If no improvement after 24-48 hours, oral vancomycin max dose may be increased to 2 g/d
Q6hr IV metronidazole, 30 mg/kg/d, may be added to intracolonic/enema vancomycin for ileus, inability to tolerate PO antibiotics
1-3 year old -- 250 mg vancomycin in 50 mL NS
4-9 year old -- 375 mg vancomycin in 75 mL NS
> 9 year old -- 500 mg vancomycin in 100 mL NS
Multiple recurrences, other strategies, in consult with pediatric GI:
May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults
Consider PO fidaxomicin in ≥ 6 year old patients at 200 mg twice daily for 10 dats
PO metronidazole 30 mg/kg/d in four divided doses, max 2 g/day
PO vancomycin 40 mg/kg/d in four divided doses, max 500 mg/day
If no improvement after 24-48 hours, oral vancomycin max dose may be increased to 2 g/d
Q6hr IV metronidazole, 30 mg/kg/d, may be added to intracolonic/enema vancomycin for ileus, inability to tolerate PO antibiotics
1-3 year old -- 250 mg vancomycin in 50 mL NS
4-9 year old -- 375 mg vancomycin in 75 mL NS
> 9 year old -- 500 mg vancomycin in 100 mL NS
1-3 year old -- 250 mg vancomycin in 50 mL NS
4-9 year old -- 375 mg vancomycin in 75 mL NS
> 9 year old -- 500 mg vancomycin in 100 mL NS
May benefit from tapering and pulse oral vancomycin over 1.5-2 months, as done in adults
Consider PO fidaxomicin in ≥ 6 year old patients at 200 mg twice daily for 10 dats
Clostridium difficile 
Viral 
Salmonella
Bacterial
Campylobacter jejuni
Campylobacter
Yersinia enterocolitica
Shigella