Treatment and prevention of antibiotic associated diarrhea
Treatment and prevention of antibiotic associated diarrhea
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DOI：
10.1016/s0924-8579(00)00293-4
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发表时间：
2000-12-01
影响因子：
10.8
通讯作者：
Bergogne-Bérézin, E
中科院分区：
文献类型：
--
作者：
Bergogne-Bérézin, E
抗生素相关性腹泻（AAD）的轻度或重度发作是抗生素治疗的常见副作用。AAD的发生率因抗生素而异，从5%到25%不等。肠道疾病的主要形式是与艰难梭菌相关的伪膜性结肠炎，其发生在所有AAD的10-20%中。在大多数情况下，停用AAD或用另一种AAD风险较低的药物替代激发抗生素可能是有效的。对于C.艰难梭菌，腹泻的治疗需要抗生素治疗，使用糖肽类（万古霉素）或甲硝唑。AAD治疗或预防的另一种方法是基于使用能够重建肠道生态系统平衡的非致病性活生物体。几种生物体已被用于治疗或预防AAD，例如嗜酸乳杆菌（Lactobacillus acidophilus），L.保加利亚双歧杆菌、长双歧杆菌和屎肠球菌。已使用另一种生物活性剂，一种非致病性酵母，布拉酵母（Saccharomyces boulardii）。在C.克林霉素引起的艰难性结肠炎，用S.布拉氏菌（万古霉素治疗结束时）的C.艰难梭菌集落形成单位和毒素B的产生。在一些临床随机试验中（与安慰剂相比），S。布拉地已证明其有效性，通过显着减少C。艰难梭菌结肠炎和预防毒素A和B的致病作用。很难它已被证明是一种安全有效的治疗复发的C。艰难性结肠炎用S.只有布拉地。在ICU中，AAD的预防仍然基于限制抗生素的过度使用和C.应通过改善卫生措施（单人间、患者专用浴室、工作人员使用手套和洗手）预防艰难梭菌或其他AAD病原体。此外，生物降解剂如S.布拉地霉素应允许预防抗生素的主要副作用，即处于风险中的患者中的AAD。(C)2000年Elsevier Science B. V.和国际化疗学会。All rights reserved.
Mild or severe episodes of antibiotic-associated diarrhea (AAD) are common side effects of antibiotic therapy. The incidence of AAD differs with the antibiotic and varies from 5 to 25%. The major form of intestinal disorders is the pseudomembranous colitis associated with Clostridium difficile which occurs in 10-20% of all AAD. In most cases of AAD discontinuation or replacement of the inciting antibiotic by another drug with lower AAD risk can be effective. For more severe cases involving C. difficile, the treatment of diarrhea requires an antibiotic treatment, with glycopeptides (vancomycin) or metronidazole. Another approach to AAD treatment or prevention is based on the use of non-pathogenic living organisms, capable of re-establishing the equilibrium of the intestinal ecosystem. Several organisms have been used in treatment or prophylaxis of AAD such as selected strains of Lactobacillus acidophilus, L. bulgaricus, Bifidobacterium longum, and Enterococcus faecium. Another biotherapeutic agent, a non-pathogenic yeast, Saccharomyces boulardii has been used. In animal models of C. difficile colitis initiated by clindamycin, animals treated with S. boulardii (at end of vancomycin therapy) had a significant decrease in C. difficile colony-forming units, and of toxin B production. In several clinical randomised trials (versus placebo), S. boulardii has demonstrated its effectiveness by decreasing significantly the occurrence of C. difficile colitis and preventing the pathogenic effects of toxins A and B of C. difficile. It has been shown to be a safe and effective therapy in relapses of C. difficile colitis. A good response has been seen in children with AAD, treated by S. boulardii only. In ICUs prevention of AAD remains based on limitation of antibiotic overuse and spread of C. difficile or other agents of AAD should be prevented by improved hygiene measures (single rooms, private bathrooms for patients, use of gloves and hand washing for personnel). In addition the increasing use of biotherapeutic agents such as S. boulardii should permit the prevention of the major side effect of antibiotics, i.e. AAD in at risk patients. (C) 2000 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.