Prävention von Infektionen des unteren Respirationstraktes bei Erwachsenen

Infektionen des unteren Respirationstraktes sind sehr häufig.

Infektionen des unteren Respirationstraktes sind sehr häufig. Neben der akuten Bronchitis, die in der Regel durch Viren bedingt ist und vermutlich 10 - 20 % der Bevölkerung einmal jährlich trifft, spielen vor allen Dingen infektionsbedingte Exazerbationen der chronischen Bronchitis und der COPD sowie ambulant erworbene Pneumonien eine große Rolle. Bei einer geschätzten Prävalenz der chronischen Bronchitis und COPD in der Bevölkerung von 5 % kann von mehreren Millionen infektionsbedingter Exazerbationen dieser Krankheitsbilder pro Jahr ausgegangen werden. An einer ambulant erworbenen Pneumonie erkranken jährlich ca. 800 000 Personen in Deutschland.

Im Folgenden sollen Möglichkeiten der Prävention bzw. Prophylaxe von Infektionen des unteren Respirationstraktes dargestellt werden und ihre Effektivität anhand der zur Zeit verfügbaren Literatur bewertet werden.

Abb. 1 Influenza-Viren (nach Nicholson KG, Wood JM, Zambon M. Influenza. Lancet 2003; 362: 1733 - 1745).

Literatur

• 1 Bridges C B, Winquist A G, Fukuda K. et al . Advisory Committee on Immunization Practies: Prevention and control of influenza.  MMWR Recomm Rep. 2000;  49 1-38
• 2 Beyer W E, de Bruijn I A, Palache A M. et al . Protection against influenza after annually repeated vaccination: a meta-analysis of serologic and field studies.  Arch Intern Med. 1999;  159 (2) 182-188
• 3 Demicheli V, Rivetti D, Deeks J J. et al . Vaccines for preventing influenza in healthy adults.  Cochrane Database Syst Rev. 2001;  (4) CD001269
• 4 Gross P A, Quinnan Jr G V, Weksler M E. et al . Immunization of elderly people with high doses of influenza vaccine.  J Am Geriatr Soc. 1988;  36 (3) 209-212
• 5 STIKO . Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand.  Epidemiol Bull. 2004;  30 235-250
• 6 Bernstein E, Kaye D, Abrutyn E. et al . Immune response to influenza vaccination in a large healthy elderly population.  Vaccine. 1999;  17 (1) 82-94
• 7 Nichol K. Improving influenza vaccination rates for high-risk inpatients.  Am J Med. 1991;  91 584-588
• 8 Nichol K L, Margolis K L, Wouremna J. et al . Effectiveness of influenza vaccine in the elderly.  Gerontology. 1996;  42 (5) 274-279
• 9 Nichol K L, Margolis K L, Wuorenma J. et al . The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community.  N Engl J Med. 1994;  331 (12) 778-784
• 10 Nichol K L. Cost-benefit analysis of a strategy to vaccinate healthy working adults against influenza.  Arch Intern Med. 2001;  161 (5) 749-759
• 11 Govaert T M, Sprenger M J, Dinant G J. et al . Immune response to influenza vaccination of elderly people. A randomized double-blind placebo-controlled trial.  Vaccine. 1994;  12 (13) 1185-1189
• 12 Gross P A, Hermogenes A W, Sacks H S. et al . The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature.  Ann Intern Med. 1995;  123 (7) 518-527
• 13 Nichol K L, Baken L, Nelson A. Relation between influenza vaccination and outpatients visits, hospitalization, and mortality in elderly persons with chronic lung disease.  Ann Intern Med. 1999;  130 (5) 397-403
• 14 Laver G, Garman E. Pandemic influenza: its origin and control.  Microbes Infect. 2002;  4 (13) 1309-1316
• 15 Tam J S. Influenza A (H5N1) in Hong Kong: an overview.  Vaccine. 2002;  20 Suppl 2 77-81
• 16 Jefferson T O, Demicheli V, Deeks J J. et al . Amantadine and rimantadine for preventing and treating influenza A in adults.  Cochrane Database Syst Rev. 2002;  (3) CD001169
• 17 Jefferson T, Demicheli V, Deeks J. et al . Neuraminidase inhibitors for preventing and treating influenza in healthy adults.  Cochrane Database Syst Rev. 2000;  (2) CD001265
• 18 Boivin G, Goyette N. Susceptibility of recent Canadian influenza A and B virus isolates to different neuraminidase inhibitors.  Antiviral Res. 2002;  54 (3) 143-147
• 19 Sintchenko V, Gilbert G L, Coiera E. et al . Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results.  J Clin Virol. 2002;  25 (1) 15-21
• 20 Oxford J S, Bossuyt S, Balasingam S. et al . Treatment of epidemic and pandemic influenza with neuraminidase and M2 proton channel inhibitors 696.  Clin Microbiol Infect. 2003;  9 (1) 1-14
• 21 Schaberg T. Pneumokokken-Schutzimpfung.  Pneumologie. 2001;  55 (12) 543-545
• 22 Hedlund J U, Kalin M E, Ortqvist A B. et al . Antibody response to pneumococcal vaccine in middle-aged and elderly patients recently treated for pneumonia.  Arch Intern Med. 1994;  154 (17) 1961-1965
• 23 Cornu C, Yzebe D, Leophonte P. et al . Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials.  Vaccine. 2001;  19 (32) 4780-4790
• 24 Nichol K L, Baken L, Wuorenma J. et al . The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease.  Arch Intern Med. 1999;  159 (20) 2437-2442
• 25 Medical Research Council . Value of chemoprophylaxis and chemotherapy in early chronic bronchitis. A report to the Medical Research Council by their working party on trials of chemotherapy in early chronic bronchitis.  Br Med J. 1966;  5499 1317-1322
• 26 Johnston R N, McNeill R S, Smith D H. et al . Five-year winter chemoprophylaxis for chronic bronchitis.  Br Med J. 1969;  4 (678) 265-269
• 27 Mars G, Santarato R, Necchi D, Silva A. Prolonged minimal dose administration of sulphamethopyrazine in the treatment and prophylaxis of infectious diseases in the old.  Panminerva Med. 1997;  9 607-610
• 28 Black P, Staykova T, Chacko E. et al . Prophylactic antibiotic therapy for chronic bronchitis 112.  Cochrane Database Syst Rev. 2003;  (1) CD004105
• 29 Ramsey B, Pepe M S, Quan J M. et al . Intermittent administration of inhaled tobramycin in patients with cystic fibrosis.  N Engl J Med. 1999;  340 23-30
• 30 The COPD Guidelines Group of the Standards of Care Committee of the BTS . BTS guidelines for the management of chronic obstructive pulmonary disease.  Thorax. 1997;  52 1-28
• 31 Bradley J, Moran F, Greenstone M. Physical training for bronchiectasis.  Cochrane Database Syst Rev. 2002;  (3) CD002166
• 32 Varekojis S M, Douce F H, Flucke R L. et al . A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients.  Respir Care. 2003;  48 (1) 24-28
• 33 Jones A, Rowe B H. Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review.  Heart Lung. 2000;  29 (2) 125-135
• 34 Poole P J, Black P N. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2003;  (2) CD001287
• 35 Melchart D, Linde K, Fischer P. et al . Echinacea for preventing and treating the common cold.  Cochrane Database Syst Rev. 2000;  (2) CD000530
• 36 Belongia E A, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults.  Am J Med. 2001;  111 (2) 103-108
• 37 Vickers A J, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes.  Cochrane Database Syst Rev. 2000;  (2) CD001957
• 38 Marshall I. Zinc for the common cold.  Cochrane Database Syst Rev. 2000;  (2) CD001364
• 39 Jackson J L, Lesho E, Peterson C. Zinc and the common cold: a meta-analysis revisited.  J Nutr. 2000;  130 (5S Suppl) 1512-1515
• 40 Foxwell A R, Cripps A W. Haemophilus influenzae oral vaccination against acute bronchitis.  Cochrane Database Syst Rev. 2003;  (2) CD001958
• 41 Steurer-Stey C, Bachmann L M, Steurer J. et al . Oral purified bacterial extracts in chronic bronchitis and COPD: a systematic review.  Chest. 2004;  126 1645-1655