臨牀消化器内科 Vol.19 No.8(2-6)


特集名 感染性腸炎
題名 [各論]抗生物質と腸炎
発刊年月 2004年 07月
著者 勝木 伸一 敬和会時計台病院消化器病センター
著者 本間 久登 敬和会時計台病院消化器病センター
著者 秋山 剛英 札幌医科大学内科学第四講座
著者 村上 研 札幌医科大学内科学第四講座
著者 女澤 慎一 敬和会時計台病院消化器病センター
著者 高山 哲治 札幌医科大学内科学第四講座
【 要旨 】 抗生物質起因性腸炎には,大きく分けて,急性出血性腸炎,偽膜性腸炎,MRSA腸炎の3型に分類される.急性出血性腸炎は,主としてペニシリン系抗生物質投与後に発症し,その機序として,アレルギーや虚血性変化,Klebsiella oxytocaClostridium difficile感染などが推測されている.偽膜性腸炎は,高齢者や悪性腫瘍患者,血液疾患患者に抗生物質を投与した際に発症することが多く,Clostridium difficile toxin Aやtoxin Bがその原因とされる.MRSA腸炎発症には,第三世代セフェム系抗生物質投与と酸分泌抑制の二つの要因が必要と考えられる.
Theme Infectious Enterocolitis
Title Antibiotic Associated Enterocolitis
Author Shinichi Katsuki Center for Gastroenterology, Keiwakai Tokeidai Hospital
Author Hisato Homma Center for Gastroenterology, Keiwakai Tokeidai Hospital
Author Takehide Akiyama The Fourth Department of Internal Medicine, Sapporo Medical University
Author Ken Murakami The Fourth Department of Internal Medicine, Sapporo Medical University
Author Shinichi Mezawa Center for Gastroenterology, Keiwakai Tokeidai Hospital
Author Tetsuji Takayama The Fourth Department of Internal Medicine, Sapporo Medical University
[ Summary ] Antibiotic associated diarrhea is a common symptom for the majority of clinicians. We can classify enterocolitis into three types; acute hemorrhagic colitis, pseudomembranous colitis and MRSA enteritis. Acute hemorrhagic colitis is mainly caused by oral usage of penicillin and its derivatives. The cause of this disease is still unknown but it is suggested that allergic reactions, ischemic changes or overgrowth of Klebsiella oxytoca and Clostridium difficile toxin may be linked. Pseudomembranous colitis is commonly detected in older people and patients having malignant or blood related diseases who have been given antibiotics. This disease is caused by Clostridium difficile toxin A and B. MRSA enteritis has recently become a common disease and is seen as a nosocomial infection. Third generatinon cephalosporin administration and gastric acid inhibition are necessary to treat MRSA infections in the intestinal mucosa.
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