Werner H
Fortschr Med. 1979 Sep 6;97(33):1411-4.
Pseudomembranous colitis has been recognized as a complication of antimicrobial therapy since 1952. Most recently, evidence has been accumulated showing that a heat labile toxin is involved. Though little is known so far about the normal ecology of C. difficile and the host factors of potential importance in the development of colitis by this anaerobe, antimicrobial agent-induced suppression of the normal gut flora seems to be a major factor leading to the intestinal proliferation of resistant toxinogenic C. difficile. Factors independent of susceptibility are, however, probably responsible for cases of pseudomembranous colitis associated with penicillin, ampicillin, and other antibiotics active against C. difficile. In monitoring antibiotic therapy, the application of selective media for the isolation of C. difficile from faecal specimens and proper tools for the demonstration of toxin and the study of immunity might prove to be fruitful from both a diagnostic and therapeutic viewpoint. In established pseudomembranous colitis treatment consists of oral vancomycin (2 g/day), cholestyramine and, if necessary, intensive intravenous regimen.
自1952年以来,伪膜性结肠炎一直被认为是抗菌治疗的一种并发症。最近,已有证据表明一种热不稳定毒素与之有关。尽管到目前为止,关于艰难梭菌的正常生态学以及该厌氧菌引发结肠炎时潜在重要的宿主因素了解甚少,但抗菌药物导致的正常肠道菌群抑制似乎是导致耐药产毒素艰难梭菌在肠道内增殖的主要因素。然而,与青霉素、氨苄西林及其他对艰难梭菌有效的抗生素相关的伪膜性结肠炎病例,可能是由与易感性无关的因素引起的。在监测抗生素治疗时,应用选择性培养基从粪便标本中分离艰难梭菌,以及使用合适的工具来检测毒素和研究免疫,从诊断和治疗角度来看可能会有成效。对于已确诊的伪膜性结肠炎,治疗方法包括口服万古霉素(2克/天)、考来烯胺,必要时采用强化静脉给药方案。