Wenisch C, Parschalk B, Hasenhündl M, Hirschl A M, Graninger W
Department of Infectious Diseases, University Hospital of Vienna, Austria.
Clin Infect Dis. 1996 May;22(5):813-8. doi: 10.1093/clinids/22.5.813.
We conducted a prospective, randomized study to compare the efficacy of oral fusidic acid, oral metronidazole, oral vancomycin, and oral teicoplanin for the treatment of Clostridium difficile-associated diarrhea. Treatment resulted in clinical cure for 94% of the patients who were treated with vancomycin, 96% of those treated with teicoplanin, 93% of those treated with fusidic acid, and 94% of those treated with metronidazole. Clinical symptoms recurred in 16% of patients treated with vancomycin, 7% of those treated with teicoplanin, 28% of those treated with fusidic acid, and 16% of those treated with metronidazole. There was asymptomatic carriage of C. difficile toxin in 13% of patients treated with vancomycin, 4% of those treated with teicoplanin, 24% of those treated with fusidic acid, and 16% of those treated with metronidazole. No adverse effects related to therapy with vancomycin or teicoplanin were observed. Considering the costs of treatment, our findings suggest that metronidazole is the drug of choice for C. difficile-associated diarrhea and that glycopeptides should be reserved for patients who cannot tolerate metronidazole or who do not respond to treatment with this drug.
我们进行了一项前瞻性随机研究，以比较口服夫西地酸、口服甲硝唑、口服万古霉素和口服替考拉宁治疗艰难梭菌相关性腹泻的疗效。治疗结果显示，接受万古霉素治疗的患者中94%临床治愈，接受替考拉宁治疗的患者中96%临床治愈，接受夫西地酸治疗的患者中93%临床治愈，接受甲硝唑治疗的患者中94%临床治愈。接受万古霉素治疗的患者中有16%临床症状复发，接受替考拉宁治疗的患者中有7%临床症状复发，接受夫西地酸治疗的患者中有28%临床症状复发，接受甲硝唑治疗的患者中有16%临床症状复发。接受万古霉素治疗的患者中有13%有无症状艰难梭菌毒素携带，接受替考拉宁治疗的患者中有4%有无症状艰难梭菌毒素携带，接受夫西地酸治疗的患者中有24%有无症状艰难梭菌毒素携带，接受甲硝唑治疗的患者中有16%有无症状艰难梭菌毒素携带。未观察到与万古霉素或替考拉宁治疗相关的不良反应。考虑到治疗成本，我们的研究结果表明，甲硝唑是艰难梭菌相关性腹泻的首选药物，糖肽类药物应保留用于不能耐受甲硝唑或对该药物治疗无反应的患者。
