Antibakterielle Prophylaxe von Harnwegsinfektionen

Zusammenfassung

Aktuelle prospektive, Placebo-kontrollierte Studien sprechen für eine Effektivität der antibakteriellen Infektionsprophylaxe gegenüber rezidivierenden Harnwegsinfektionen, insbesondere bei vesikorenalem Reflux im Kindesalter. Ein signifikanter Einfluss auf die Entwicklung frischer pyelonephritischer Nierenschädigungen konnte in diesen Studien nicht nachgewiesen werden.

Zu den Hauptindikationen für eine risikoorientierte antibakterielle Langzeit-Infektionsprophylaxe gehören der höhergradige vesikorenale Reflux (VUR), obstruktive Uropathien (z. B. obstruktiver Megaureter, Urethralklappen) und häufig rezidivierende, symptomatische HWI. Im Kindesalter zählen Nitrofurantoin, Trimethoprim und Cephalosporine zu den am meisten verwendeten Substanzen.

Die Prophylaxe darf sich nicht nur auf die Verordnung von antibakteriell wirksamen Medikamenten beschränken. Ebenso wichtig sind die Behandlung von Blasenfunktionsstörungen, Stuhlregulierung und die Beseitigung anderer prädisponierender Faktoren.

Es ist notwendiger denn je, die Indikationen für eine antibakterielle Prophylaxe kritisch zu überprüfen und diejenigen Kinder zu identifizieren, die einen eindeutigen Nutzen von einer längerfristigen antimikrobiellen Prophylaxe haben. Aktuelle Resistenzentwicklung, unerwünschte Nebenwirkungen von Chemotherapeutika und Akzeptanzprobleme erfordern die intensive Suche nach Alternativen in der Prophylaxe von Harnwegsinfektionen.

Summary

The results of current prospective, Placebo-controlled studies argue for an efficacy of antimicrobial prophylaxis in recurrent urinary tract infections, especially in children with vesicorenal reflux. However, a significant influence on pyelonephritic damages could not be proved.

Risk-oriented antibacterial prophylaxis is commonly used in symptomatic dilating VUR, in severe obstructive uropathies (i. e. urethral valve, obstructive megaureter) and in recurrent symptomatic UTIs. In infancy and childhood, Nitrofurantoin, Trimethoprim and Cephalosporines are prescribed most frequently. Prophylaxis should not be restricted to the use of antibiotics or other prophylactic agents but must also include the efficient management of bladder and/or bowel dysfunction, as well as the treatment of other predisposing factors.

To put antibacterial prophylaxis on its place, risk groups for recurrent symptomatic infections, ascending UTI and permanent renal damage have to be actually defined. The efficacy of prophylaxis in these groups has to be proved by further prospective randomized studies. Beyond that, current trends in bacterial resistance, adverse events with antibacterial substances and reducing acceptance necessitate more than ever clinical research in preventive alternatives.

Schlüsselwörter

Harnwegsinfektion - Pyelonephritis - antibakterielle Infektionsprophylaxe - Nierenparenchymschädigung - vesikoureteraler Reflux - Blasenfunktionsstörung

Keywords

Urinary tract infection - pyelonephritis - prophylaxis - renal damage - vesicoureteric reflux - bladder dysfunction

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