Tannous George, Neff Guy, Kemmer Nyingi
Department of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Case Rep Gastroenterol. 2010 Sep 28;4(3):404-409. doi: 10.1159/000320685.
We report the case of a 46-year-old white male with confirmed Clostridium difficile infection for >4 weeks after fluoroquinolone therapy. The patient received two courses of metronidazole 500 mg three times daily (t.i.d.) during which time diarrhea resolved; however, symptoms recurred 14-15 days after treatment termination. He received a 2-week course of vancomycin 125 mg four times daily, with symptoms recurring 10 days after treatment conclusion. The patient then received a pulsed tapering schedule of vancomycin with adjunctive Saccharomyces boulardii. Diarrhea recurred 12 days after treatment completion. He received rifaximin 400 mg t.i.d. while hospitalized for diarrhea-associated complications. Symptoms resolved within 24 h. The patient received a 4-week regimen of rifaximin 400 mg orally t.i.d. after discharge. No further episodes of diarrhea were reported within 6 months after treatment termination. The present case supports the potential benefit of rifaximin for the treatment of recurrent Clostridium difficile infection.
我们报告了一例46岁白人男性病例，该患者在接受氟喹诺酮治疗后确诊艰难梭菌感染超过4周。患者接受了两个疗程的甲硝唑治疗，每日三次，每次500毫克，在此期间腹泻症状缓解；然而，治疗结束后14 - 15天症状复发。他又接受了一个为期2周的万古霉素治疗疗程，每日四次，每次125毫克，治疗结束后10天症状再次出现。随后，患者接受了万古霉素脉冲递减给药方案并辅以布拉氏酵母菌。治疗完成后12天腹泻再次发作。因腹泻相关并发症住院期间，他接受了利福昔明治疗，每日三次，每次400毫克，症状在24小时内缓解。出院后，患者接受了为期4周的利福昔明口服治疗方案，每日三次，每次400毫克。治疗结束后6个月内未再报告腹泻发作。本病例支持利福昔明在治疗复发性艰难梭菌感染方面的潜在益处。
