SAVREMENI PRISTUP U TERAPIJI INFEKCIJA IZAZVANIH SA CLOSTRIDIUM DIFFICILE

  • Saša Jaćović "Univerzitet u Kragujevcu, Fakultet Medicinskih Nauka, Odsek za farmaciju
  • Slobodan Milisavljević Fakultet Medicinskih Nauka
  • Miloš N Milosavljević Fakultet Medicinskih Nauka
  • Slobodan M Janković Fakultet Medicinskih Nauka
  • Srdjan M Stefanović Fakultet Medicinskih Nauka
DOI: https://doi.org/10.5937/racter10-18509
Ključne reči: bezlotoxumab||, ||bezlotoksumab, Vancomycin||, ||vankomicin, Recurrence||, ||povratak, Metronidazole||, ||metrondiazol, Intestines||, ||unutrašnji organi, Infection||, ||infekcija, Clostridium difficile||, ||clostridium difficile, Clostridium||, ||klostridium,

Sažetak


Kolitis uzrokovan bakterijom Clostridium difficile (CDC) nastaje kao rezultat poremećaja ravnoteže bakterija u gastrointestinalnom traktu, uglavnom zbog prethodne sistemske primene antibiotika širokog spektra dejstva. U današnje vreme ova vrsta kolitisa predstavlja jednu od najučestalijih infekcija stečenih u bolničkoj sredini. Pri tome, danas se kliničari često suočavaju sa rastućom incidencijom fulminantnih i rekurentnih CDC, koji su praćeni brojnim kolektomijama, produženim boravakom u bolnici, fatalnim ishodom i povećanjem sveukupnih troškova zdravstvene zaštite. Tradicionalni antibiotici za lečenje CDC-a, poput metronidazola, vankomicina ili fidaksomicina, u prethodnim istraživanjima pokazali su određene terapijske nedostatke. Stoga je cilj ovog narativnog revijalnog rada bio da se kritički proceni efikasnost svakog od preporučenih lekova za CDC, kao i učestalost i ozbiljnost neželjenih događaja koji prate njihovu primenu.Na osnovu aktuelnih saznanja, dijapazon standardnih antibiotika odobrenih za lečenje inicijalne ili rekurentne CDC prilično je ograničen. Bez obzira na težinu CDC, oralni ili rektalni vankomicin danas se smatra terapijskom opcijom prve linije kod odraslih, dok fidaksomicin ili metronidazol predstavljaju odgovarajuće alternative. S druge strane, metronidazol je lek izbora za lečenje inicijalne i prve rekurentne epizode CDC u dečijoj populaciji. Drugi potencijalno efikasni antimikrobni lekovi za CDC, poput rifaksimina, nitazoksanida, fusidinske kiselina, tigeciklina, bacitracina i  probiotika, ne mogu se preporučiti kao terapija izbora s obzirom da u prethodnim istraživanjima u pogledu kliničkih efekata nisu pokazali nikakve prednosti u odnosu na vankomicin ili fidaksomicin. U pokušaju da se reši problem rekurentnih CDC događaja, što je jedan od najvažnijih izazova sa kojima se danas sreću zdravstveni radnici, dodatna upotreba humanog monoklonskog antitela protiv toksina B CD (bezlotoksumab) uz standardni način lečenja ili infuzija suspenzije fecesa zdravih donora u debelo crevo pacijenta (fekalna transplantacija), mogu biti efikasan i bezbedan terapijski pristup u situacijama gde su takve procedure dostupne. Do završetka kliničkog razvoja inovativne terapije za CDC, poput novih antibiotika i vakcina protiv Clostridium difficile, primarni fokus treba da bude na efikasnoj prevenciji ove infekcije, u smislu unapređenja racionalne upotrebe sistemskih antibiotika šrokog spektra dejstva i inhibitora protonske pumpe.

Biografija autora

Saša Jaćović, "Univerzitet u Kragujevcu, Fakultet Medicinskih Nauka, Odsek za farmaciju
Magistar farmacije

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Objavljeno
2019/02/17
Broj časopisa
Vol. 10 Br. 2 (2018): Racionalna Terapija
Rubrika
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