New antimicrobial agents for patients with Clostridium difficile infections.
New antimicrobial agents for patients with Clostridium difficile infections.
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DOI：
10.1007/s11908-009-0004-8
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发表时间：
2009-01-01
影响因子：
3.1
通讯作者：
Bartlett, John G
中科院分区：
文献类型：
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作者：
Bartlett, John G
目前艰难梭菌感染（CDI）的药物治疗主要集中在甲硝唑和万古霉素。早期研究显示等效性，但最近的报告表明口服万古霉素是严重CDI的首选。最近的研究表明，由于NAP-1菌株的挑战，需要新的药物，NAP-1菌株似乎会导致更难治的疾病，更容易复发。这两种治疗方法是最具挑战性的。本文综述了正在开发的新药物：抗生素、益生菌、免疫反应产物和结合C。艰难梭菌毒素对于急性感染，没有一种药物可能比口服万古霉素更有效。然而，有几种可能同样有效，不会导致复发或促进不必要的抗生素使用多种条件。最有希望的是用于中断复发的药物。在这一类别中，主要的新药剂似乎是抗生素（利福昔明、硝唑尼特、地夫米星、雷莫拉宁）、毒素结合剂（托伐莫）、益生菌（布拉酵母菌和分枝乳杆菌）和免疫剂（类毒素疫苗和超免疫球蛋白）。根据最近的试验，最有希望的药物是利福昔明、托伐莫和difimicin，它们似乎有希望减少复发。
Current drug treatment of Clostridium difficile infection (CDI) focuses on metronidazole and vancomycin. Early studies showed equivalence, but more recent reports indicate that oral vancomycin is preferred for serious CDI. Recent work has demonstrated a need for new drugs due to challenges with the NAP-1 strain, which appears to cause more refractory disease that is more likely to relapse. These two distinctive facets of treatment are the most challenging. This review discusses new agents in development: antibiotics, probiotics, immune response products, and agents to bind C. difficile toxins. None are likely to be more effective than oral vancomycin for acute infection. However, several may be as effective, without causing relapse or promoting unnecessary antibiotic use for multiple conditions. The greatest promise is with agents used to interrupt relapses. In this category the leading new agents appear to be antibiotics (rifaximin, nitazoxanide, difimicin, ramoplanin), toxin-binding agents (tolevamer), probiotics (Saccharomyces -boulardii and Lactobacillus ramosus), and immune agents (toxoid vaccine and hyperimmune globulin). The drugs that appear most promising based on recent trials are rifaximin, tolevamer, and difimicin, which appear promising for reducing relapses.