The Pediatric C difficile Surge and What Pharmacists Can Do

Pharmacy Times^® interviewed Stacy A. Kahn, MD, director of Fecal Microbiota Transplantation and attending physician at Boston Children's Hospital in Massachusetts, on her presentation titled “C difficile: A Big Problem for Little Kids” at the Peggy Lillis Foundation's 2025 C diff Summit in Washington, DC.

Kahn discussed the growing threat of Clostridioides difficile (C difficile) infection in children, particularly community-acquired cases. She highlighted concerns around high recurrence rates and the lack of effective treatments approved for children. Kahn emphasized the urgent need for more research, advocacy, and pediatric-approved therapies. She also underscored the importance of pharmacists staying current with evolving literature and collaborating with health care teams to improve prevention and treatment outcomes.

Clostridium difficile bacteria. Image Credit: © Artur - stock.adobe.com

Pharmacy Times: What was the topic of your presentation at the Peggy Lillis Foundation's 2025 C diff Summit?

Stacy A. Kahn, MD: Today, I talked about the tremendous threat that [C difficile] poses to all people, but particularly children in general. We know historically that [C difficile] has been a condition that affects adults. We have seen that although the overall incidence of [C difficile] has gone down, there is an increase in occurrence rates, and we are seeing an increase in the incidence of pediatrics [C difficile]. This is particularly troubling, not only because we're seeing more children who are sick, but we are also seeing that these children who come down with [C difficile] are developing it for reasons that are unknown. So, these are cases that are considered community acquired. So, these are children who have not been hospitalized, have not had surgeries, do not have other medical problems, and do not have many of the typical risk factors that you see in adult patients or hospitalized individuals.

About 75% of the cases in the US are in children and are community acquired, meaning that we are just beginning to understand what a serious problem this is for pediatric patients. We also know that antibiotics are effective for only a handful of patients, and that recurrence rates of C difficile infection are upwards of 15% to 30% in children as well as adults, meaning that you may take multiple courses of antibiotics and not achieve cure for [C difficile], meaning that you're developing a recurrence from what should be a really relatively short, but very unpleasant, infection.

The newer therapeutics that are available are not currently approved for pediatric patients, and they are not approved for patients who have severe fulminant [C difficile]. So there is a huge gap in care for those populations. As is the case with many therapies, they are first approved in adults, and lag time for pediatric approval can be upwards of 8 to 10 years. So, there is a tremendous need for not only more research, but more advocacy and work, specifically in the field of pediatrics to address this growing health threat.

Pharmacy Times: What is the role and potential impact of the pharmacist in C difficile prevention and treatment among children?

Kahn: I think staying current with the literature is really important for anybody in the health care field, not just pharmacists, but nurses, doctors, [physicians assistants (PAs)], and advanced nurse practitioners. I find that even today, if I see a clinic patient and they ask a question, I find myself going back to the literature, because what's been published in the last 2 weeks or 3 weeks or 4 weeks? So, I think really staying well informed is one of our best tools. I think that understanding that the literature in pediatrics is very small competitive to what we know in adults and really relying on experts and consensus statements for guiding treatment [is important]. Maybe what you learned when you were getting your master's degree in pharmacy or your bachelor's may not hold true anymore. Certainly, when I did training, metronidazole was the first-line treatment for C difficile. We really now know that with most cases, there are other treatments that are much more effective and have a higher chance of achieving cure and don't have the same kind of effects that are so unpleasant. So just making sure that you're aware of the literature.

I think another opportunity would be to really stay in touch with your team. If you work with physicians, if you work with PAs, nurses—stay in touch. I think that the best way we can help advance this field is to work together as a team.