Case reports
Severe ciprofloxacin-associated pseudomembranous colitis in an eight-year-old child

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Abstract

Clostridium difficile is the principal cause of antibiotic-associated diarrhea and pseudomembranous enterocolitis in children. A case of severe pseudomembranous colitis developing in an 8-year-old child who had received oral ciprofloxacin therapy as part of an investigational protocol is presented. The safety and efficacy of fluoroquinolones in children has not yet been established. Use of these antibiotics in children outside investigational protocols (“off-label” use) as oral antipseudomonas agents is discouraged.

Section snippets

Case report

The patient is a 9-year-old boy born at 23 weeks’ gestation with sacral agenesis and neurogenic bladder. At 3 years of age this child presented with his first urinary tract infection and had left vesicoureteral reflux diagnosed, which, after an initial trial of medical management, was treated with ureteral reimplantation. The patient was first seen by us at 8 years of age after an episode of acute pyelonephritis. At that time, clean-intermittent catheterization, anticholinergics, and antibiotic

Discussion

Clostridium difficile is the principal cause of antibiotic-associated colitis and diarrhea in adults and children. Colitis is mediated by 2 potent exotoxins produced by this organism: (1) toxin A, an enterotoxin that induces increased fluid secretion and elicits an acute intestinal mucosal inflammatory response with granulocyte infiltration, epithelial cell necrosis, ulceration, and hemorrhagic edema and (2) toxin B, a powerful cytotoxin. Toxin A seems to be the principal mediator of intestinal

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