Department of Medicine, University of Chicago, Chicago, IL, USA.
Expert Rev Anti Infect Ther. 2011 Jul;9(7):767-77. doi: 10.1586/eri.11.53.
The incidence of Clostridium difficile has doubled over the past 15 years, and rising mortality rates associated with this infection have followed in its wake. C. difficile infection (CDI) has supplanted methicillin-resistant Staphylococcus aureus as the major cause of nosocomial infection. An insufficient response rate to currently available CDI therapies has prompted the search for new and alternative treatment modalities for this disease. The investigational pipeline includes evaluation of new antimicrobial agents that exhibit good activity against C. difficile without altering normal gut flora, C. difficile toxin-absorbing compounds, and preformed antibodies and vaccines against C. difficile toxin. In two robust clinical trials comparing fidaxomicin to vancomycin in the treatment of CDI, treatment with fidaxomicin demonstrated a superior global cure (cure without recurrence) rate compared with the current gold standard, vancomycin. Fidaxomicin, the first of a new class of macrocyclic antimicrobial agents, represents an advance in the management of CDI.
过去 15 年来，艰难梭菌的发病率翻了一番，随之而来的是与这种感染相关的死亡率上升。艰难梭菌感染（CDI）已取代耐甲氧西林金黄色葡萄球菌，成为医院感染的主要原因。目前可用的 CDI 治疗方法的反应率不足，促使人们寻找这种疾病的新的和替代的治疗方法。研究管道包括评估对艰难梭菌具有良好活性而不改变正常肠道菌群的新型抗菌药物、艰难梭菌毒素吸附化合物以及针对艰难梭菌毒素的预先形成的抗体和疫苗。在两项比较 fidaxomicin 与万古霉素治疗 CDI 的强有力的临床试验中，与当前的金标准万古霉素相比，fidaxomicin 治疗显示出更高的总体治愈率（无复发治愈）率。fidaxomicin 是一类新型大环抗菌药物中的第一种，代表着 CDI 管理的一项进步。
