Clostridium difficile Associated Diarrhea and Colitis
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Abstract
ภาวะท้องร่วงและลำไส้ใหญ่อักเสบจากเชื้อ Clostridium dificile เป็นปัญหาแทรกซ้อนที่สำคัญยาปฏิชีวนะ มักเกิดตามหลังการใช้ยาปฏิชีวนะในกลุ่ม clindamycin, ampicillin, amoxycillin และ cephalosporin รุ่นที่ 2 หรือ 3 อาการแสดงทางคลินิกมีได้ตั้งแต่ไม่มีอาการ ท้องร่วง ลำไส้อักเสบทั้งไม่รุนแรงและรุนแรง ภาวะท้องร่วงมักเกิดใน 2-3 วันหลังได้ยาปฏิชีวนะโดยฉพาะผู้ป่วยที่พักรักษาตัวในโรงพยาบาล อาจพบได้หลังจากหยุดยาปฏิชีวนะไปแล้วนานถึง 6-8 สัปดาห์ กลไกการเกิดโรคเชื่อว่ายาปฏิชีวนะที่ได้รับไปทำลายเชื้อจุลินทรีย์ที่อยู่ในลำไส้ ทำให้เชื้อ Clostridiam dificile นี้เพิ่มจำนวนมากขึ้นและสร้างสารพิษก่อให้เกิดพยาธิสภาพตามมา วิธีมาตรฐานในการวินิจฉัยโรคต้องอาศัยการตรวจหาสารพิษชนิดบีในอุจจาระ ซึ่งสารพิษนี้มีฤทธิ์ต่อเซลล์ทดลอง เมื่อตรวจด้วยกล้องส่องตรวจลำไส้ใหญ่จะพบลักษณะตั้งแต่ปกติ เยื่อบุลำไส้บวมแดงเล็กน้อย ตะปุ่มตะป่ำ มีเลือดดออกหรือมีแผ่นเยื่อสีขาวเหลืองปกคลุมอยู่การรักษาประกอบด้วยการหยุดยาปฏิชีวนะที่สงสัยจะทำให้เกิดภาวะนี้ ให้การรักษาตามอาการหรือประคับประคองเรื่องอุจจาระร่วงและการให้ยาปฏิชีวนะเพื่อกำจัดเชื้อ Clostridium difficile นี้ เช่น metronidazole หรือ vancomycin เป็นเวลา 10-14 วัน ส่วนใหญ่อาการต่าง ๆ จะดีขึ้นภายใน 3-5 วัน แต่สามารถเกิดการติดเชื้อซ้ำได้ร้อยละ 20 โดยเฉพาะภายใน 2-3 วันหลังหยุดยาปฏิชีวนะที่ฆ่าเชื้อนี้ การรักษาด้วยยาสูตรเดิมและระยะเวลาเท่าเดิมมักจะได้ผลดี การป้องกันการเกิดภาวะนี้ต้องอาศัยการใช้ยาปฏิชีวนะเมื่อมีข้อบ่งชี้ที่ชัดเจน ไม่พร่ำเพรื่อการล้างมือทุกครั้งหลังสัมผัสผู้ป่วยทุกรายและให้ผู้ป่วยกลับบ้านโดยไว ถ้าไม่มีความจำเป็นต้องพักรักษาตัวในโรงพยาบาล
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