Gerding Dale N, Muto Carlene A, Owens Robert C
Hines Veterans Affairs Hospital, Hines, IL 60141, USA.
Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S32-42. doi: 10.1086/521860.
Recent outbreaks of Clostridium difficile infection (CDI) in North America have been due to a more virulent, possibly more resistant strain that causes more-severe disease, making prompt recognition of cases and optimal management of infection essential for a successful therapeutic outcome. Treatment algorithms are presented to help guide the management of patients with CDI. Metronidazole has been recommended as initial therapy since the late 1990s and continues to be the first choice for all but seriously ill patients and those with complicated or fulminant infections or multiple recurrences of CDI, for whom vancomycin is recommended. Other options for recurrent CDI, such as probiotics and currently available anion-exchange resins, have limited efficacy and are potentially harmful. Intravenous immunoglobulin may benefit patients with refractory, recurrent, or severe disease, but no controlled data are available. Two antimicrobials available in the United States for other indications, nitazoxanide and rifaximin, have been used successfully for CDI treatment but, like metronidazole, lack United States Food and Drug Administration approval for this indication. Experimental treatments currently in clinical development include a toxin-binding polymer, tolevamer; 2 poorly absorbed antimicrobials, OPT-80 (formerly known as Difimicin) and ramoplanin; monoclonal antibodies; and a C. difficile vaccine.
北美近期艰难梭菌感染（CDI）的暴发是由一种毒性更强、可能耐药性也更强的菌株引起的，这种菌株会导致更严重的疾病，因此及时识别病例并对感染进行最佳管理对于取得成功的治疗效果至关重要。本文介绍了治疗算法，以帮助指导CDI患者的管理。自20世纪90年代末以来，甲硝唑一直被推荐作为初始治疗药物，除病情严重的患者以及患有复杂或暴发性感染或CDI多次复发的患者（推荐使用万古霉素）外，甲硝唑仍是首选药物。复发性CDI的其他治疗选择，如益生菌和现有的阴离子交换树脂，疗效有限且可能有害。静脉注射免疫球蛋白可能对难治性、复发性或重症疾病患者有益，但尚无对照数据。美国有两种用于其他适应症的抗菌药物，硝唑尼特和利福昔明，已成功用于CDI治疗，但与甲硝唑一样，未获得美国食品药品监督管理局（FDA）对此适应症的批准。目前正在临床开发的实验性治疗方法包括一种毒素结合聚合物托拉菌素；两种吸收性差的抗菌药物OPT-80（原名地菲米星）和雷莫拉宁；单克隆抗体；以及一种艰难梭菌疫苗。
