Probiotika in der Prävention der Antibiotika-induzierten Diarrhö

Zusammenfassung

Zwischen 5 und 49 % der mit Antibiotika behandelten Patienten leiden an einer Diarrhö. Grundsätzlich können alle Antibiotika eine Diarrhö verursachen, besonders häufig jedoch orale Antibiotika wie Cephalosporine, Clindamycin, Breitspektrum-Penicilline und Gyrasehemmer der 3. und 4. Generation. Die Ausprägung Antibiotika-assoziierter Diarrhöen reicht von milden, selbstlimitierenden Formen bis zu schweren lebensbedrohlichen Verläufen. Die potenziell gefährlichste Form wird durch die von Clostridium difficile produzierten Toxine A und B hervorgerufen und tritt bei rund 25 % aller durch Antibiotika ausgelösten Durchfälle auf. Ein breites Spektrum probiotischer Stämme wurde im Laufe der vergangenen 2 Jahrzehnte hinsichtlich ihres prophylaktischen Potenzials gegenüber AB-assoziierter Diarrhö (AAD) bei Kindern und Erwachsenen evaluiert. Aufgrund des Wirkspektrums und der Studienlage ergeben sich unterschiedliche Evidenzgrade und Empfehlungen zum präventiven Einsatz von Probiotika bei Antibiotika-assoziierten Diarrhöen.

Abstract

Between 5 and 49 % of patients treated with antibiotics suffer from diarrhoea. Principally all microbial agents can cause diarrhoea, especially oral agents like cephalosporines, clindamycin, broad-spectrum penicillins, and quinolones of the 3 rd and 4th generation. Manifestations of antibiotic-associated diarrhoea range from mild self-limiting forms to severe life-threatening courses. The potentially most severe form of antibiotic-associated diarrhoea is caused by Clostridium diffcile accounting for approx. 25 % of antibiotic-associated diarrhoea. In the past two decades a broad spectrum of different probiotic strains has been evaluated for the primary prevention of antibiotic-associated diarrhoea in children and adults. Based on their efficacy and clinical data, different levels of evidence and recommendations are emerging on the preventive use of probiotics in antibiotic-associated diarrhoea.

Schlüsselwörter

Probiotika - Antibiotika-assoziierte Diarrhö - Clostridium difficile

Key words

probiotics - antibiotic-associated diarrhoea - Clostridium difficile

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