Vaishnavi Chetana
Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2015 Apr;141(4):398-407. doi: 10.4103/0971-5916.159251.
Clostridium difficile is one of the many aetiological agents of antibiotic associated diarrhoea and is implicated in 15-25 per cent of the cases. The organism is also involved in the exacearbation of inflammatory bowel disease and extracolonic manifestations. Due to increase in the incidence of C. difficile infection (CDI), emergence of hypervirulent strains, and increased frequency of recurrence, the clinical management of the disease has become important. The management of CDI is based on disease severity, and current antibiotic treatment options are limited to vancomycin or metronidazole in the developing countries. this review article briefly describes important aspects of CDI, and the new drug, fidaxomicin, for its treatment. Fidaxomicin is particularly active against C.difficile and acts by inhibition of RNA synthesis. Clinical trials done to compare the efficacy and safety of fidaxomicin with that of vancomycin in treating CDI concluded that fidaxomicin was non-inferior to vancomycin for treatment of CDI and that there was a significant reduction in recurrences. The bactericidal properties of fidaxomicin make it an ideal alternative for CDI treatment. However, fidaxomicin use should be considered taking into account the potential benefits of the drug, along with the medical requirements of the patient, the risks of treatment and the high cost of fidaxomicin compared to other treatment regimens.
艰难梭菌是抗生素相关性腹泻的多种病原体之一，在15%至25%的病例中起作用。该菌还与炎症性肠病的恶化及结肠外表现有关。由于艰难梭菌感染（CDI）发病率上升、高毒力菌株的出现以及复发频率增加，该病的临床管理变得至关重要。CDI的管理基于疾病严重程度，在发展中国家，目前的抗生素治疗选择仅限于万古霉素或甲硝唑。这篇综述文章简要描述了CDI的重要方面以及用于治疗的新药非达霉素。非达霉素对艰难梭菌具有特别的活性，其作用机制是抑制RNA合成。比较非达霉素与万古霉素治疗CDI疗效和安全性的临床试验得出结论，在治疗CDI方面非达霉素不劣于万古霉素，且复发率显著降低。非达霉素的杀菌特性使其成为CDI治疗的理想替代药物。然而，考虑到该药物的潜在益处、患者的医疗需求、治疗风险以及与其他治疗方案相比非达霉素的高成本，应谨慎考虑使用非达霉素。
