Bezlotoxumab as Treatment for Recurrent/Chronic Clostridioides difficile Infection in Pediatric Stem Cell Transplant Recipients: A Multi-Institutional Experience.

Clostridioides difficile infection (CDI) represents a significant health risk to pediatric stem cell transplant (SCT) patients. In these patients, recurrent CDI is common, requiring prolonged antibiotic usage and increased hospitalization. Bezlotoxumab, a monoclonal antibody that targets the toxin responsible for CDI, has demonstrated efficacy in adult studies and was recommended for the prevention of recurrent CDI in the adult population. However, the safety and efficacy of bezlotoxumab in pediatric SCT patients have not been extensively described. Moreover, the drug was discontinued in January 2025 for reasons unknown. Here, we describe a series of cases where bezlotoxumab was used in conjunction with antibiotic therapy to effectively treat recurrent CDI in pediatric SCT patients. Bezlotoxumab was not associated with increased adverse events, did not impact management of graft-versus-host disease, and was safe to use in pediatric patients in the peri-transplantation period.

Duke Scholars

Author Kris Mahadeo Pediatrics, Transplant and Cellular Therapy