New antimicrobial agents for patients with Clostridium difficile infections

被引：24

作者：

Bartlett J.G. ^{[1
]}

机构：

[1] Johns Hopkins University, School of Medicine, Baltimore, MD 21205

来源：

Current Infectious Disease Reports | 2009年 / 11卷 / 1期

关键词：

Vancomycin; Metronidazole; Antimicrob Agent; Rifaximin; Fusidic Acid;

D O I：

10.1007/s11908-009-0004-8

中图分类号：

学科分类号：

摘要：

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. © Current Medicine Group LLC 2009.

引用

页码：21 / 28

页数：7

共 69 条

[41]

McVay C.S., Rolfe R.D., In vitro and in vivo activities of nitazoxanide against Clostridium difficile, Antimicrob Agents Chemother, 44, pp. 2254-2258, (2000)

[42]

Musher D.M., Logan N., Hamill R.J., Et al., Nitazoxanide for the treatment of Clostridium difficile colitis, Clin Infect Dis, 43, pp. 421-427, (2006)

[43]

Musher D.M., Logan N., Mehendiratta V., Et al., Clostridium difficile colitis that fails conventional metronidazole therapy: Response to nitazoxanide, J Antimicrob Chemother, 59, pp. 705-710, (2007)

[44]

Taylor N.S., Bartlett J.G., Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins, J Infect Dis, 141, pp. 92-97, (1980)

[45]

Burbige E.J., Milligan F.D., Pseudomembranous colitis. Association with antibiotics and therapy with cholestyramine, JAMA, 231, pp. 1157-1158, (1975)

[46]

Mogg G.A., George R.H., Youngs D., Et al., Randomized controlled trial of colestipol in antibiotic-associated colitis, Surg, 69, pp. 137-139, (1982)

[47]

Barker Jr. R.H., Dagher R., Davidson D.M., Et al., Review article: Tolevamer, a novel toxin-binding polymer: Overview of preclinical pharmacology and physicochemical properties, Aliment Pharmacol Ther, 24, pp. 1525-1534, (2006)

[48]

Louie T.J., Peppe J., Watt C.K., Et al., Tolevamer, a novel nonantibiotic polymer, compared with vancomycin in the treatment of mild to moderately severe Clostridium difficile-associated diarrhea, Clin Infect Dis, 43, pp. 411-420, (2006)

[49]

Hickson M., D'souza A.L., Muthu N., Et al., Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: Randomized double blind placebo controlled trial, BMJ, 335, (2007)

[50]

Goldin B.R., Gorbach S.L., Clinical indications for probiotics: An overview, Clin Infect Dis, 46, SUPPL. 2, (2008)

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