Savremeni pristup u terapiji infekcija izazvanih sa Clostridium difficile

Abstract

Infection caused by Clostridium difficile (CDI) occurs as a result of imbalance of bacteria in intestinal tract mainly due to previous exposure to wide-spectrum systemic antibiotics. Nowadays, it is recognized as one of the most frequent infections acquired in hospitals. Contemporary clinicians often face an increased incidence of fulminant and recurrent CDIs that are accompanied with a number of colectomies, prolonged stay in hospitals, fatal outcome, and rising healthcare costs. Traditional antibiotics for CDI, such as metronidazole, vancomycin or fidaxomicin, have been linked to certain treatment limitations in previous studies. Thus, the aim of this narrative mini literature review was to critically evaluate efficiency of each of the recommended modern therapy modalities for CDI, as well as the frequency and severity of adverse events associated with their use. Based on current knowledge, the range of standard antibiotics approved for treatment of initial or recurrent CDI remains quite limited. Regardless of severity of CDI, oral or rectal vancomycin should be considered as the first-line therapeutic option in adults and children, while fidaxomicin or metronidazole could be an appropriate alternative. The other potentially effective antimicrobials against CDI, such as rifaximin, nitazoxanide, fusidic acid, tigecyclin, bacitracin and use of probiotics cannot be advised as the therapy of choice, as they did not provide any advantage over vancomycin or fidaxomicin in prior investigations. In an attempt to solve the problem of recurrent CDI events, which is one of the most important challenges facing health professionals today, adjunct use of human monoclonal antibody against toxin B (bezlotoxumab) or instillation of normal colonic bacteria obtained from healthy donor into patient's intestine (Fecal Microbiota Transplantation), could be effective and safe approach where available. Besides clinical development of innovative therapy for CDI, such as new antibiotics and vaccines, primary focus should be on effective prevention of this infection, in terms of improving rational use of broad-spectrum systemic antibiotics and proton pump inhibitors.