Rationale Antibiotikatherapie in der ambulanten medizinischen Versorgung

Kernaussagen

In Deutschland werden für die Behandlung von Patienten ca. 85 % aller Antibiotika in der ambulanten medizinischen Versorgung verschrieben und nur ca. 15 % in den Krankenhäusern. Schätzungen gehen davon aus, dass ca. 50 % der Antibiotikaverordnungen unnötig oder inadäquat sind. Die häufigsten Infektionen, die ambulant diagnostiziert werden, sind Infektionen der oberen Atemwege und Harnwegsinfektionen. Mehr als 80 % der Atemwegsinfektionen wie die sog. grippalen Infekte oder die Bronchitis werden viral verursacht, wogegen Antibiotika unwirksam sind. Immer häufiger werden in Deutschland in der ambulanten Versorgung Antibiotika eingesetzt mit einem sehr breiten Wirkungsspektrum wie Chinolone, Dritt- und Viertgenerations-Cephalosporine und Makrolide, was zu einem Selektionsdruck und zunehmender Resistenzentwicklung gegenüber diesen Antibiotika führt. Der Einsatz von „Biomarkern“ wie Procalcitonin und C-reaktives Protein sowie multimodale Schulungen zum rationalen Einsatz von Antibiotika und die Aufklärung der Patienten können dazu beitragen, die Wirksamkeit der verfügbaren Antibiotika möglichst lange zu erhalten.

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