Hansen, Frederik Bonde

Hansen, Stine Maagaard

Larsen, Julie Paludan

Palme, Isabella Brasch

Baggrund: I Europa kan der ses en stigning i patienter indlagt og diagnosticeret med tarmbakterien Clostridium difficile. Infektionen kan have fatale konsekvenser, hvis patientens immunsystem i tarmen er beskadiget. Nuværende behandlingsmetoder er ikke effektive nok, og flere patienter oplever tilbagevendende infektioner. De tilbagevendende infektioner er ofte endnu værre end det foregående forløb.Formål: Dette projekt vil udforske de forskellige behandlinger, der i dag bliver brugt på de danske hospitaler. Derudover vil det undersøge hvilke faktorer, som spiller en afgørende rolle i valget af behandling. Gennem denne undersøgelse vil der også lægges fokus på de fremtidige behandlinger samt forebyggelse og en sammenligning af disse. Målet er at besvare hvilken metode der har de bedste fremtidsudsigter.Metode: Der er lavet et omfattende litteraturstudie for at indsamle de nødvendige informationer, der bliver brugt til at sammenligne de antibiotika samt behandlinger, som bliver brugt i dag eller er under udvikling. Litteratur af fremtidige behandlingsmuligheder gennemgik en udvælgelsesproces, hvori alle kliniske forsøg udover fase III forsøg blev valgt fra. Desuden blev kliniske studier, der allerede er gennemført, valgt fra. De udvalgte er sammenlignet med den nuværende forebyggelse og behandlinger.Resultater: De nuværende forebyggende metoder og behandling mod CDI er generelle infektionshygiejniske retningslinjer og behandling med metronidazol, vancomycin, fidaxomicin, FMT samt behandling med antistoffet bezlotoxumab. Der er i alt udvalgt seks fremtidige alternative behandlinger. De seks, der er udvalgt, består af to duplikater af et klinisk forsøg med det nye antibiotikum ridinilazol, to studier med SER-109, som er tarmmikrober fra doneret fæces prøver, én vaccine og et forsøg med tarmbakterier i suspension kaldet RBX2660. Nogle af disse kan bruges i fremtiden enten som erstatning eller som supplement til nuværende behandlingsmetoder.Konklusion: Sammenligningen har vist, at de vigtigste faktorer, der gør sig gældende ved valget af behandlingsmetode er økonomi, effektivitet og risikoen for resistensudvikling. En forebyggende vaccine kan i nogle tilfælde være effektivt til forebyggelse hos patienter i risikogruppen. Derudover vil en vaccine promovere patienters sundhed og trivsel på hospitalerne, samt reducere brugen af antibiotika og dermed mindske risikoen for antibiotika resistens.Background: A rise in hospitalized patients around Europe are diagnosed with a bacterial in-fection caused by Clostridium difficile. The infection can in some cases be fatal if a patient’s colon immune system is somehow damaged. The current treatment methods are not efficient enough and many patients experience a relapse. The returning infection are often even worse than the former.Objective: This project seeks to explore the different medical treatment associated and used by the Danish hospitals, and to investigate what factors that play a major role when choosing a treatment. Under this investigation the project will also focus on upcoming treatments as well as prevention and compare the two. The goal is to answer what solution that has the best prospects.Method: A comprehensive literature review has been made in order to gather the necessary information to compare the assortment of antibiotics and other treatments used or that are under development. Literature of upcoming treatments underwent a selection where all other clinical trial phases than phase III were discarded. In addition to this, all completed studies were discarded as well, so that only the ongoing with enough information was left. The chosen once would be compared with the current prevention and treatments.Results: The current prevention and treatment of CDI are general hygiene and control strategies and treatment with metronidazole, vancomycin, fidaxomicin, FMT and the antibody bezlotoxumab. The upcoming prevention and treatment methods include six studies with alternative treatment-methods than the once that are currently used. The six chosen are two duplicated clinical trials of a new antibiotic called ridinilazole, two studies involving intestinal microbes from fecal donations called SER-109, one vaccine and a microbiota suspension RBX2660. Some of them can be used in the future either as a replacement or as a supplement to current treatments. Conclusion: Comparison of the different treatments shows that factors such as economy, efficiency and the development of antibiotic resistance plays an important role when choosing a treatment method. A preventive treatment, like a vaccine, can in some situations be effective to prevent infections in certain risk groups. Thus, promoting patient’s health and well-being. Also reducing usage of antibiotics lowering the chance of antibiotic resistance

Present and upcoming treatments including prevention of Clostridium difficile infection

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Roskilde Universitet