困難梭狀芽孢桿菌相關腹瀉之臨床與藥物治療新進展

Clostridium Difficile-associated Diarrhea: An Update on Medical Treatment

近二十年困難梭狀芽孢桿菌相關腹瀉在流行病學與治療方面都有顯著的改變。在醫療相關腹瀉的個案中，困難梭狀芽孢桿菌扮演著重要的致病因，且社區型感染有增加的趨勢。現今全世界廣泛探討著更具毒力之困難梭狀芽孢桿菌所引發的病情幾乎與抗生素使用有關。近幾年的文獻指出，metronidazole在治療困難梭狀芽孢桿菌相關腹瀉成效上相較於萬古黴素（vancomycin）有減弱的趨勢。因此我們藉由文獻回顧，探討該疾病在藥物治療上的進展。

In the past decade, the epidemiology and treatment of Clostridium difficile-associated diarrhea (CDAD) have significantly changed. C. difficile remains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. The most virulent strain of C. difficile has persisted after the use of nearly all of the systemic antibacterial agents worldwide and has been responsible for the most severe cases of CDAD. In recent years, research has shown that metronidazole is less effective in treating CDAD than vancomycin. However, despite the increasing data available in the literature, controversy remains over the best treatment plans for CDAD. In the present paper, we review developments in antimicrobial therapy, including the introduction of the recently FDA-approved agent fidaxomicin, and currently available non-antimicrobial strategies for CDAD management.