口服万科米辛用于预防复发性困难菌感染:一项随机临床试验
Julie A Keating1,2, Tinghui Xu3, Mary Beth Graham4
1Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison.
JAMA network open
|July 2, 2025
概括
口服万科米辛预防可能会减少复发性Clostridioides difficile感染 (CDI),但在本试验中没有达到统计学意义. 需要进一步的研究来证实万科米辛在预防复发性CDI方面的疗效.
科学领域:
- 传染性疾病 传染性疾病
- 临床试验 临床试验
- 微生物学 微生物学
背景情况:
- 系统性抗生素使用是复发性Clostridioides difficile感染 (CDI) 的重要危险因素.
- 口服万科米越来越多地用于对复发性CDI的二次预防,但其有效性尚不确定.
研究的目的:
- 评估与安慰剂相比,口服万科米辛预防的有效性,以预防复发性CDI.
- 评估在研究治疗期间和研究治疗后8周内复发性CDI的发生率.
主要方法:
- 第2阶段,安慰剂控制,双盲随机临床试验,涉及成年人治疗CDI在180天内,并接受系统性抗生素用于另一个适应症.
- 参与者在抗生素治疗期间和治疗后5天接受了口服万科米辛 (125毫克每天一次) 或安慰剂.
- 主要结局:复发性CDI发病率;次要结局:携带抗胺素耐药性肠球菌 (VRE).
主要成果:
- 复发性CDI发生在43.6%的万科米辛组和57.1%的安慰剂组中 (绝对差异:13.5%;95%CI,-35.1%至8.0%).
- 不良事件在各组之间是相似的 (69.2%的万科米辛和64.3%的安慰剂).
- 与安慰剂 (24.0%) (P=.048) 相比,万科米辛组 (50.0%) 的VRE携带显着更高.
结论:
- 这项研究表明,口服万科米辛可减少复发性CDI的潜在趋势,但这并没有达到统计学意义.
- 该试验没有足够的力量来得出关于万科米辛在预防复发性CDI的有效性方面的确结论.
- 增加抗万科胺素的Enterococcus携带是一个值得注意的发现,需要考虑.
相关概念视频
Drugs for Treatment of Diarrhea-Predominant IBS
289
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
289
Drugs for Treatment of Ulcerative Colitis in IBD
236
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
236
Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
201
Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
201
Antimicrobial Effectiveness
156
The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
156
Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
546
Helicobacter pylori, a resilient gram-negative bacterium, can thrive in the stomach's harsh, acidic environment. Infection with H. pylori leads to a cascade of events within the stomach lining. One of the critical disruptions caused by this bacterium is the interference with somatostatin production, a hormone responsible for regulating acid secretion. This interference tips the balance, escalating acid secretion and diminishing bicarbonate levels. This imbalance compromises the defensive...
546
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
200
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
200


