Antibiotika und der Gastrointestinaltrakt

Kernaussagen

Infektiöse Durchfallerkrankungen

• 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.

Andere bakterielle Infektionen

• 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.

• Neben klaren Entscheidungen für eine operative Therapie, bei der die Antibiotikatherapie nur adjuvanten Charakter besitzt, sind die Kenntnis und Wertung von Erregereigenschaften wie Resistenzen und wirtseigenen Faktoren wichtig für die optimale und sichere Auswahl geeigneter Therapeutika.

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