Juang Paul, Hardesty Jennifer S
Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO, USA.
J Pharm Pract. 2013 Oct;26(5):491-7. doi: 10.1177/0897190013499526.
Clostridium difficile is a gram-negative, anaerobic, spore-forming emerging pathogen within health care systems and community-based populations that has a high associated morbidity and mortality as well as cost for the health care system. Recent studies reported high rates of recurrence thus a need for new pharmacological agents to treat C difficile infections (CDIs). Fidaxomicin is a novel macrocyclic antibiotic, originally isolated from fermentation broth of Dactylosporangium aurantiacum spp Hamdenensis, with selective spectrum, unique pharmacokinetic and pharmacodynamics profile, adverse effect profile, efficacy, and role in the treatment of and time to recurrent CDI. Fidaxomicin data have similar clinical cure, when compared to vancomycin, with lower recurrence rates and higher global cure rates in non-BI/NAP1/027 strains. Fidaxomicin also lacks activity against gram-negative bacteria; hence, its potential effect on resistance development among enteric bacteria appears to be low. It appears to have minimal need for renal or hepatic adjustments and minimal concerns for drug-drug interactions. Overall, fidaxomicin has been generally well tolerated with the most common adverse effects reported as mild gastrointestinal complaints. Fidaxomicin appears to have a role in the treatment of CDI with potential lower rates of recurrence, especially in patients with severe disease or risk factors for recurrent CDI.
艰难梭菌是一种革兰氏阴性、厌氧、产芽孢的新兴病原体，在医疗保健系统和社区人群中存在，具有较高的发病率、死亡率以及医疗保健系统成本。最近的研究报告了高复发率，因此需要新的药物来治疗艰难梭菌感染（CDI）。非达霉素是一种新型大环内酯类抗生素，最初从橙色指孢囊菌哈氏亚种的发酵液中分离出来，具有选择性光谱、独特的药代动力学和药效学特征、不良反应特征、疗效以及在治疗复发性CDI中的作用和复发时间。与万古霉素相比，非达霉素的数据具有相似的临床治愈率，在非BI/NAP1/027菌株中复发率较低，总体治愈率较高。非达霉素对革兰氏阴性菌也没有活性；因此，它对肠道细菌耐药性发展的潜在影响似乎较低。它似乎对肾脏或肝脏的调整需求最小，对药物相互作用的担忧也最小。总体而言，非达霉素的耐受性普遍良好，最常见的不良反应是轻度胃肠道不适。非达霉素似乎在治疗CDI中发挥作用，复发率可能较低，尤其是在患有严重疾病或有复发性CDI风险因素的患者中。
