4例抗生素相关性腹泻的病例分析及治疗建议
Analysis of 4 Cases of Antibiotic-Associated Diarrhea and Suggestions for Treatment
王瑞慧 1陈頔2
作者信息
- 1. 北京市丰台区南苑社区卫生服务中心,北京 100076
- 2. 北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,北京 100730
- 折叠
摘要
目的:抗生素相关性腹泻不良后果严重,艰难梭菌是抗生素相关性腹泻的最常见病原体,通过分析抗生素相关性腹泻病例,为临床治疗提供建议和参考.方法:对北京医院4例抗生素相关性腹泻病例的危险因素、治疗方案、预防措施进行分析.结果:病例存在的危险因素包括高龄、抗生素治疗、长期住院、使用质子泵抑制剂等,抗菌药物治疗是发生抗生素相关性腹泻的重要危险因素.4个案例属于艰难梭菌轻中度至重度感染,口服万古霉素进行治疗后好转.病例存在用药疗程不足、未及时停用止泻药及质子泵抑制剂等问题.结论:以往甲硝唑是轻度至中度艰难梭菌的首选药物,现已被万古霉素取代.由于万古霉素口服生物利用度低,在粪便中浓度高,可口服治疗艰难梭菌感染,治疗标准疗程应为10～14 d或抗生素治疗结束后1周.同时应注意避免使用止泻剂及不必要的质子泵抑制剂,尽量使用风险较低的抗生素,减少患病风险.
Abstract
Objective:The adverse consequences of antibiotic-associated diarrhea are serious,and clostridium difficile is the most common pathogen.The purpose of this study is to provide suggestions and references for clinical treatment through analyzing the cases of antibiotic-associated diarrhea.Methods:The risk factor,treatment plan and preventive measures of 4 cases of antibiotic-associated diar-rhea in Beijing Hospital were analyzed.Results:The risk factors include advanced-age,exposure to antibiotics,long-term hospitaliza-tion,and use of proton pump inhibitors.Antibacterial therapy is an important risk factor for antibiotic-associated diarrhea.The four cases were mild,moderate to severe clostridium difficile infection,and the symptoms improved after oral vancomycin treatment.Prob-lems were found such as insufficient medication duration,failure to stop antidiarrheal medication and proton pump inhibitors in time.Conclusion:Vancomycin has replaced metronidazole as the preferred treatment for mild to moderate clostridium difficile.Due to the low oral bioavailability and high concentration of vancomycin in feces,it can be used to treat clostridium difficile orally.The standard dura-tion of treatment should be 10-14 d or 1 week after the end of antibiotic treatment.Antidiarrheal medication and unnecessary proton pump inhibitors should be avoided,as well as lower-risk antibiotics should be used to reduce the risk of disease.
关键词
抗生素相关性腹泻/艰难梭菌感染/治疗/预防Key words
Antibiotic-associated diarrhea/Clostridium difficile infection/Treatment/Prevention引用本文复制引用
基金项目
北京大学医学部教育教学研究课题(2022YB38)
出版年
2024
NETL
NSTL
万方数据