Occurrence of Clostridium difficile toxin-associated gastroenteritis following antibiotic therapy for otitis media in young children.

The pathogenesis of diarrhea following antibiotic therapy for otitis media in young children remains unknown. We performed a prospective study evaluating the incidence of diarrhea and Clostridium difficile toxin in 115 outpatients (ages 6 months to 6 years) with acute otitis media treated with ampicillin, amoxicillin or trimethoprim-sulfamethoxazole. In 21 patients younger than one year of age six of 11 developing diarrhea had toxin-positive stools compared with three of 10 without diarrhea (P = 0.39). In 94 patients between 13 months and 6 years of age three of 12 with diarrhea had toxin-positive stools compared with five of 82 without diarrhea (P = 0.06). Diarrhea was self-limited in all cases. Although the data suggest that C. difficile might have been associated with diarrhea in the older children, further studies will be required to confirm this finding.