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Gastroenterologie up2date 2019; 15(01): 79-104
DOI: 10.1055/a-0641-1861
Infektiologie
Georg Thieme Verlag KG Stuttgart · New York

Antibiotika und der Gastrointestinaltrakt – Update 2019

Christoph Lübbert
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Publication History

Publication Date:
27 March 2019 (online)

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Updated by:

Antibiotika und der GastrointestinaltraktGastroenterologie up2date 2015; 11(03): 161-182
DOI: 10.1055/s-0034-1392718

Infektiöse Durchfallerkrankungen zählen zu den häufigsten Erkrankungen weltweit und sind laut der Weltgesundheitsorganisation eine der 5 häufigsten Todesursachen [1]. Dieser Beitrag beleuchtet den Einsatz von Antibiotika bei Infektionen des Gastrointestinaltrakts und die zunehmende Resistenzentwicklung der Erreger. Die antibiotischen Therapien der einzelnen Krankheitsbilder werden detailliert dargestellt und wichtige Hygienemaßnahmen erläutert.
Kernaussagen

  • Die symptomatische Therapie steht bei der Behandlung von infektiös bedingten Durchfallerkrankungen im Vordergrund. Der Nutzen einer empirischen Antibiotikatherapie ist umstritten.

  • Situationen, die eine gezielte Erregerdiagnostik und evtl. auch spezifische Therapie erfordern, sind: schweres Krankheitsbild, prolongierte Diarrhö, Zeichen einer Organinvasivität des Erregers, vermuteter Ausbruch, Immunsuppression und signifikante Komorbidität.

  • Die gezielte antimikrobielle Therapie von schweren infektiös bedingten Durchfallerkrankungen setzt eine differenzierte mikrobiologische Stuhluntersuchung voraus.

  • Antibiotikaresistenzen – gerade bei importierten Fällen (vor allem aus Indien) – sind in zunehmendem Maße zu berücksichtigen.

  • Anders sieht es bei bakteriell bedingten Infektionen von Magen, Leber, Gallenwegen oder Peritonealraum aus. Hier stellt die in der Regel empirisch verabreichte Antibiotikatherapie eine wichtige Säule im Behandlungskonzept dar.

  • Im Vordergrund stehen klare Entscheidungen für eine operative Therapie (Fokussanierung), bei der die Antibiotikatherapie nur adjuvanten Charakter besitzt. Darüber hinaus sind die Kenntnis und Wertung von Erregereigenschaften wie Resistenzen und wirtseigenen Faktoren wichtig für die optimale und sichere Auswahl geeigneter Therapeutika.

Schlüsselwörter

Antibiotika - Gastrointestinaltrakt - Infektion - Diarrhö - Clostridium difficile
 

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