Esposito Susanna, Umbrello Giulia, Castellazzi Luca, Principi Nicola
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Expert Rev Gastroenterol Hepatol. 2015 Jun;9(6):747-55. doi: 10.1586/17474124.2015.1039988. Epub 2015 Apr 25.
Clostridium difficile causes infections that can either remain asymptomatic or manifest as clinical disease. In this report, problems, possible solutions, and future perspectives on the treatment of C. difficile infections (CDIs) in pediatric patients are discussed. CDI, despite increasing as a consequence of the overuse and misuse of antibiotics, remains relatively uncommon in pediatrics mainly because younger children are poorly susceptible to the action of C. difficile toxins. In most such cases, C. difficile disease is mild to moderate and discontinuation of the administered antibiotics in patients receiving these drugs when CDI develops, or administration of metronidazole, is sufficient to solve this problem. In severe or frequently relapsing cases, vancomycin is the drug of choice. Probiotics do not seem to add significant advantages. Other treatment options must be reserved for severe cases and be considered as a salvage treatment, although potential advantages in pediatric patients remain unclear.
艰难梭菌可引发感染，这些感染可能无症状，也可能表现为临床疾病。在本报告中，我们讨论了小儿患者艰难梭菌感染（CDI）治疗方面的问题、可能的解决方案以及未来展望。尽管由于抗生素的过度使用和滥用，CDI有所增加，但在儿科中仍相对不常见，主要是因为年幼儿童对艰难梭菌毒素的作用不易感。在大多数此类病例中，艰难梭菌疾病为轻至中度，当CDI发生时，停用正在接受治疗的抗生素，或者对正在接受这些药物治疗的患者给予甲硝唑，足以解决该问题。在严重或频繁复发的病例中，万古霉素是首选药物。益生菌似乎并没有显著优势。其他治疗选择必须保留给严重病例，并被视为挽救治疗，尽管在小儿患者中的潜在优势尚不清楚。
