Johnson Stuart
Medicine Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Int J Antimicrob Agents. 2009 Mar;33 Suppl 1:S33-6. doi: 10.1016/S0924-8579(09)70014-7.
Recurrent diarrhoea after successful treatment of the primary episode is a common complication of Clostridium difficile infection (CDI) and may be increasing in frequency. Evidence suggests that persistent alterations in the indigenous bowel flora and failure to mount an effective antibody response to C. difficile toxins are the main mechanisms whereby recurrent CDIs occur. Treatment of the first recurrence with the same agent used for the treatment of the primary episode is reasonable, but a different approach is needed for patients with multiple CDI recurrences. Prolonged, repeated courses of metronidazole are discouraged, but a practical first option in these patients is to use tapered-dose oral vancomycin followed by a pulsed-dose regimen. Other potential options include probiotic approaches, restoration of the normal flora, immunological approaches, toxin-binding approaches, and serial therapy with vancomycin followed by rifaximin. Randomised studies including a sufficient numbers of patients have not yet been conducted for the treatment of recurrent CDI and are needed to help guide the formulation of effective recommendations.
艰难梭菌感染（CDI）初次发作成功治疗后出现的复发性腹泻是一种常见并发症，且其发生率可能正在上升。有证据表明，肠道固有菌群的持续改变以及未能对艰难梭菌毒素产生有效的抗体反应是复发性CDI发生的主要机制。用治疗初次发作的相同药物治疗首次复发是合理的，但对于多次CDI复发的患者则需要采取不同的方法。不鼓励长期、重复使用甲硝唑疗程，但对于这些患者，一个切实可行的首选方法是使用逐渐减量的口服万古霉素，随后采用脉冲给药方案。其他潜在选择包括益生菌方法、恢复正常菌群、免疫方法、毒素结合方法以及先使用万古霉素再使用利福昔明的序贯疗法。目前尚未针对复发性CDI的治疗开展包含足够数量患者的随机研究，而此类研究对于帮助制定有效的治疗建议是必要的。
