Department of Infectious Diseases, The Netherlands.
Curr Opin Infect Dis. 2009 Dec;22(6):517-24. doi: 10.1097/QCO.0b013e32833229ce.
The increasing incidence of Clostridium difficile infection (CDI) is confronting us with two major problems in CDI management that presently remain unsolved: refractoriness to therapy and recurrence of disease. This review focuses on recent insights in antimicrobial therapy of CDI, as well as advances in alternative treatment modalities.
In severe CDI, oral vancomycin has shown its superiority over metronidazole in two independent trials. Of new antimicrobials, nitazoxanide and fidaxomicin have shown promise, but the role of these and several other drugs such as rifaximin and tigecycline still has to be established. Additional antimicrobials display in-vitro activity against C. difficile but have not yet been studied in CDI patients. Immunotherapy currently focuses on intravenously administered antibodies directed against clostridial toxins, which may help reduce recurrence rates when given as adjunct to standard treatment. No new trials of probiotics in CDI have been published but current literature does not support their usage. The results of a first randomized trial of faecotherapy are awaited.
Currently, no evidence-based guidance can be given with respect to refractoriness to treatment and preventing recurrences after treatment for CDI. Results of clinical trials on new approaches with antimicrobials, immunotherapy or faecotherapy are urgently awaited.
艰难梭菌感染（CDI）发病率的增加使我们面临 CDI 治疗中尚未解决的两个主要问题：对治疗的耐药性和疾病的复发。这篇综述重点介绍了 CDI 抗菌治疗的最新进展，以及替代治疗方法的进展。
在严重的 CDI 中，口服万古霉素在两项独立试验中显示优于甲硝唑。在新的抗菌药物中，硝唑尼特和非达霉素显示出有希望的效果，但这些药物和其他几种药物（如利福昔明和替加环素）的作用仍有待确定。其他一些具有抗艰难梭菌活性的抗生素仍在研究中。免疫疗法目前侧重于静脉内给予针对梭菌毒素的抗体，当与标准治疗联合使用时，可能有助于降低复发率。目前还没有发表关于 CDI 中益生菌的新试验，但现有文献不支持其使用。正在等待粪便治疗的首次随机试验结果。
目前，对于 CDI 治疗的耐药性和治疗后复发的预防，尚无基于证据的指导。迫切需要对新的抗菌药物、免疫疗法或粪便疗法的临床试验结果进行评估。
