Mogg G A, Arabi Y, Youngs D, Johnson M, Bentley S, Burdon D W, Keighley M R
Scand J Infect Dis Suppl. 1980(Suppl 22):41-5.
Since September 1977 we have seen 63 patients with Clostridium difficile and a faecal toxin, but only 33 had histological evidence of pseudomembranous colitis. We have conducted separate double blind trials of an antibiotic, vancomycin and an anion-exchange resin, colestipol, in patients with post-operative diarrhoea. Vancomycin was extremely effective at eradicating the organism and its faecal toxin. These changes were associated with a marked symptomatic improvement. Colestipol proved ineffective in absorbing the faecal toxin and caused no change in numbers of Clostridial difficile. There was no associated symptomatic response. Neither drug had any effect on diarrhoea not related to Clostridium difficile. A carrier state was created by those patients who continued to excrete the organism after Colestipol or placebo treatment. This was eradicated by subsequent treatment with vancomycin. Our brief experience with metronidazole is discussed and a rational basis for treatment advocated.
自1977年9月以来，我们共诊治了63例患有艰难梭菌并伴有粪便毒素的患者，但其中仅有33例具备伪膜性结肠炎的组织学证据。我们针对术后腹泻患者，分别开展了抗生素万古霉素和阴离子交换树脂考来烯胺的双盲试验。万古霉素在根除该病原体及其粪便毒素方面极为有效。这些变化伴随着症状的显著改善。考来烯胺在吸收粪便毒素方面被证明无效，且对艰难梭菌的数量没有影响。也没有相应的症状改善反应。两种药物对与艰难梭菌无关的腹泻均无任何作用。在考来烯胺或安慰剂治疗后仍继续排出该病原体的患者形成了带菌状态。随后用万古霉素治疗可消除这种状态。我们讨论了甲硝唑的简短经验，并倡导了合理的治疗依据。
