Roshan Niloufar, Hammer Katherine A, Riley Thomas V
School of Biomedical Sciences (M504), The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
School of Biomedical Sciences (M504), The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia; Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia; School of Veterinary & Life Sciences, Murdoch University, Murdoch, WA, Australia; School of Medical & Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
Anaerobe. 2018 Feb;49:103-111. doi: 10.1016/j.anaerobe.2018.01.003. Epub 2018 Jan 6.
Clostridium difficile is an anaerobic, Gram-positive, spore-forming bacillus that causes disease ranging from self-limiting diarrhoea to severe pseudomembranous colitis. C. difficile infection (CDI) commonly affects hospitalised patients and is increasingly identified in patients in the community with no hospital contact. For the last 15 years the incidence of CDI worldwide has been rising, especially in the northern hemisphere. The yearly average number of hospitalizations as a result of this disease is estimated to be over a quarter of a million per year in the United States alone. The main risk factor for CDI is exposure to antimicrobials that affect the gut microflora and, paradoxically, the most common treatments for CDI are the antimicrobials, metronidazole and vancomycin. However, the increasing frequency of highly virulent C. difficile strains, antimicrobial treatment failures, hospital outbreaks, patients with severe complications and cases with multiple recurrences have driven the search for new therapies. Several novel or popular complementary and alternative therapies are self-prescribed for treatment of other diarrheal diseases, and these may also be appropriate for treating CDI. In general, complementary and alternative medicine (CAM) is mainly used by patients when conventional therapeutic agents show limited success against C. difficile and other antimicrobial-resistant bacteria. Among these alternative approaches, a number of treatments, such as herbal remedies, are embraced less by pharmaceutical and medical professions. This review summarises current knowledge of non-conventional antimicrobial and alternative therapies for treatment of CDI. As the demand for non-conventional antimicrobial therapies increases, further studies are required in the field of CAM, especially natural products, for the treatment of CDI.
艰难梭菌是一种厌氧、革兰氏阳性、产芽孢的杆菌，可引起从自限性腹泻到严重伪膜性结肠炎等疾病。艰难梭菌感染（CDI）通常影响住院患者，并且在没有医院接触史的社区患者中也越来越多地被发现。在过去15年中，全球CDI的发病率一直在上升，尤其是在北半球。仅在美国，每年因这种疾病住院的平均人数估计就超过25万。CDI的主要危险因素是接触影响肠道微生物群的抗菌药物，而矛盾的是，CDI最常见的治疗方法是抗菌药物甲硝唑和万古霉素。然而，高毒力艰难梭菌菌株的频率增加、抗菌治疗失败、医院爆发、严重并发症患者以及多次复发的病例促使人们寻找新的治疗方法。几种新颖或流行的补充和替代疗法被患者自行用于治疗其他腹泻疾病，这些疗法也可能适用于治疗CDI。一般来说，当传统治疗药物对艰难梭菌和其他耐药菌的治疗效果有限时，患者主要使用补充和替代医学（CAM）。在这些替代方法中，一些治疗方法，如草药疗法，较少被制药和医疗行业所接受。本综述总结了目前关于治疗CDI的非常规抗菌和替代疗法的知识。随着对非常规抗菌疗法需求的增加，在补充和替代医学领域，尤其是天然产物治疗CDI方面，需要进一步开展研究。
