困難梭狀桿菌腹瀉：治療困難之處

Clostridium Difficile-Associated Diarrhea: The Difficulties in Therapy

洪元斌(Yuan-Pin Hung) ； 李致毅(Chih-I Lee) ； 柯文謙(Wen-Chien Ko)

《內科學誌》 22卷2期 (2011/04) Pp. 133-137

https://doi.org/10.6314/JIMT.2011.22(2).07

摘要

困難梭狀桿菌，是造成住院病人抗生素相關腹瀉主要原因，症狀從輕微腹瀉到偽膜性腸炎、或是毒性巨腸症，都有可能。困難梭狀桿菌常經由醫療照顧人員雙手而傳播。治療困難梭狀桿菌感染，首要是停止不必要的抗生素使用。甲硝唑和萬古黴素，被認爲是治療困難梭狀桿菌感染首選藥物；藥物選擇可視疾病嚴重程度而有不同。甲硝唑可口服或是注射使用，用來治療多數輕到中度的感染。萬古黴素只有口服才有效，用來治療嚴重感染病患。口服萬古黴素，可能造成萬古黴素抗藥性腸球菌的腸道移生。然而，不管是以甲硝唑或是萬古黴素治療，都有復發機會；少數復發病患，不容易被治癒。益生菌和注射免疫球蛋白，在治療少數個案時有正面療效，但實際的臨床療效，仍需大規模研究證實。目前有些研究中的藥物，包括ramoplanin、rifaximin、nitazoxanide、fidaxomicin，或是舊藥，例如fusidic acid、teicoplanin，或rifampin，治療困難梭狀桿菌的角色，仍需進一步研究。部分嚴重患者需要開刀，時機包括治療失敗、發生毒性巨腸症，或是腸穿孔。加強洗手及避免不需要的抗生素使用，是常被建議的感染控制措施。總結來說，困難梭狀桿菌感染，在醫療機構有越來越多趨勢，需要即時診斷，及投予適當藥物治療，才能有好的預後。

關鍵字

困難梭狀桿菌 ； 抗生素相關腹瀉 ； 甲硝唑 ； 萬古黴素 ； 益生菌

並列摘要

Clostridium difficile is a major cause of nosocomial antibiotic-associated diarrhea, with clinical features range from mild diarrhea to pseudomembrane colitis or toxic megacolon. C. difficile is frequently transmitted in healthcare setting via health medical care workers. The first step in treating patients with C. difficile infection (CDI) is discontinuing unnecessary antibiotics. Metronidazole and vancomycin have been regarded as the primary therapy options for CDI. However the choice of initial therapy depends on the severity of disease. Metronidazole is regarded as the agent of choice for most patients with mild to moderate CDI and can be administered via oral or intravenous form. Vancomycin use is recommended for those with severe CDI but can only be used via oral route. Facilitating vancomycin-resistant enterococci colonization is a potential drawback of oral vancomycin use. However, recurrent CDI was noted under either metronidazole or vancomycin use, and it is sometimes difficult to cure recurrent CDI. Probiotics and intravenous immunoglobulin are effective in some studies, but their clinic efficacy still warrants large trials. Use of some new medications, such as ramoplanin, rifaximin, nitazoxanide, fidaxomicin, or some old medications, such as fusidic acid, teicoplanin, or rifampin, in treating CDI is still under investigation. Indications for surgery include treatment failure, development of toxic megacolon or bowel perforation. Enhancement of handwashing and avoidance of unnecessary antibiotic use are commonly recommended infection control strategies. In conclusion, as CDI is increasing in health care settings, prompt recognition of cases and optimal management of infections are essential for a favorable outcome.

並列關鍵字

Clostridium difficile ； Antibiotics associated diarrhea ； Metronidazole ； Vancomycin ； Probiotics