Departments of *Pediatric Gastroenterology and Nutrition, and †Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
Inflamm Bowel Dis. 2017 Dec;23(12):2209-2214. doi: 10.1097/MIB.0000000000001249.
Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammatory bowel disease (IBD); however, there is a paucity of data regarding the treatment of CDI in this group of patients.
This was a prospective, single-blind trial. Children with flare of IBD and CDI were randomly assigned to receive metronidazole or rifaximin orally for 14 days. CDI was diagnosed based on a positive well-type enzyme immunoassay (EIA) toxins A/B stool test for C. difficile toxins A and/or B. The cure rate was defined as the percentage of patients with a negative EIA stool test for C. difficile toxins A/B measured 4 weeks after the end of treatment. Recurrence was defined as a repeat CDI within 2 to 8 weeks.
In total, we included 31 patients with IBD including 12 patients with Crohn's disease and 19 with ulcerative colitis. Of them, 17 received metronidazole and 14 received rifaximin. There were no statistically significant differences between the 2 study groups including age, type of treatment, and disease activity. There was no statistically significant difference in the cure rate between patients treated with metronidazole and rifaximin (70.6% versus 78.6%, respectively, P = 0.5). We found no difference in recurrence rate between the 2 study treatment types (17% versus 0%, respectively, P = 0.3). We did not find an association between immunosuppressive therapy and CDI cure rate or CDI recurrence rate.
Metronidazole and rifaximin were similarly effective treatments for CDI in pediatric patients with IBD.
有趣的是，艰难梭菌感染（CDI）会使炎症性肠病（IBD）的病程恶化；然而，关于这组患者中 CDI 的治疗方法的数据却很少。
这是一项前瞻性、单盲试验。IBD 发作合并 CDI 的患儿被随机分为两组，分别接受甲硝唑或利福昔明口服治疗 14 天。CDI 的诊断依据是阳性的酶联免疫吸附试验（EIA）检测粪便中艰难梭菌毒素 A/B。治疗结束后 4 周时，EIA 粪便检测为阴性的患者比例定义为治愈率。复发定义为在 2 至 8 周内再次发生 CDI。
共纳入 31 例 IBD 患儿，其中包括 12 例克罗恩病患儿和 19 例溃疡性结肠炎患儿。其中，17 例患儿接受甲硝唑治疗，14 例患儿接受利福昔明治疗。两组患儿的年龄、治疗类型和疾病活动度均无统计学差异。甲硝唑和利福昔明治疗的治愈率无统计学差异（分别为 70.6%和 78.6%，P=0.5）。两种治疗方法的复发率也无统计学差异（分别为 17%和 0%，P=0.3）。我们未发现免疫抑制治疗与 CDI 治愈率或 CDI 复发率之间存在关联。
甲硝唑和利福昔明治疗儿童 IBD 合并 CDI 同样有效。
