The Search for a Better Treatment for RecurrentClostridium difficileDisease: Use of High‐Dose Vancomycin Combined withSaccharomyces boulardii

作者：Christina M. Surawicz, Lynne V. McFarland, Richard Neil Greenberg, Moshe Rubin, Robert Fekety, Maury Ellis Mulligan, Reuben J. Garcia, Sally A. Brandmarker, Karen Bowen, Delia Borjal, Gary W. Elmer · 发表于：Clinical Infectious Diseases · 年份：2000 · DOI：10.1086/318130 · 被引用次数：531 · 研究领域：Clostridium difficile and Clostridium perfringens research、Antimicrobial Resistance in Staphylococcus、Gut microbiota and health

Recurrent Clostridium difficile disease (CDD) is a difficult clinical problem because antibiotic therapy often does not prevent further recurrences. In a previous study, the biotherapeutic agent Saccharomyces boulardii was used in combination with standard antibiotics and was found to be effective in reducing subsequent recurrences of CDD. In an effort to further refine a standard regimen, we tested patients receiving a regimen of a standard antibiotic for 10 days and then added either S. boulardii (1 g/day for 28 days) or placebo. A significant decrease in recurrences was observed only in patients treated with high-dose vancomycin (2 g/day) and S. boulardii (16.7%), compared with those who received high-dose vancomycin and placebo (50%; P=.05). No serious adverse reactions were observed in these patients. Comparison of data from this trial with data from previous studies indicates that recurrent CDD may respond to a short course of high-dose vancomycin or to longer courses of low-dose vancomycin when either is combined with S. boulardii.