Brodszky Valentin, Gulácsi László, Ludwig Endre, Prinz Gyula, Banai János, Reményi Péter, Strbák Bálint, Kertész Adrienne, Kopcsóné Németh Irén, Zsoldiné Urbán Edit, Baji Petra, Péntek Márta
Budapesti Corvinus Egyetem Egészség-gazdaságtani és Egészségügyi Technológiaelemzési Kutatóközpont, Budapest, Fővám tér 8. 1093.
Orv Hetil. 2013 Jun 9;154(23):890-9. doi: 10.1556/OH.2013.29627.
Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable.
To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection.
Systematic review and meta-analysis of the literature data.
Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints.
Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections.
艰难梭菌是抗生素相关性医院感染性腹泻的主要病因。在过去几十年中，用于治疗艰难梭菌感染的新药品数量有限且已注册的产品较少。现有科学证据有限且难以比较。
分析甲硝唑、万古霉素和非达霉素治疗艰难梭菌感染的临床疗效和安全性。
对文献数据进行系统评价和荟萃分析。
文献数据的荟萃分析表明，这些抗生素在临床治愈终点方面无显著差异（比值比：非达霉素对比万古霉素为1.19；万古霉素对比甲硝唑为1.69；非达霉素对比甲硝唑为2.00）。然而，在复发和总体治愈终点方面，非达霉素治疗显著优于万古霉素和甲硝唑（比值比：非达霉素对比万古霉素为0.47；万古霉素对比甲硝唑为0.91；非达霉素对比甲硝唑为0.43）。在安全终点方面，非达霉素、万古霉素和甲硝唑之间无显著差异。
每种抗生素在改善临床治愈方面效果相似。非达霉素是降低艰难梭菌复发性感染率最有效的治疗选择。
