Nicht antibiotische Strategien zur Rezidivprophylaxe von unkomplizierten Harnwegsinfektionen der Frau

Zusammenfassung

Ziel ärztlichen Handelns ist das „primum nihil nocere“. Die Wiederherstellung der Integrität der intestinalen Mikrobiota und die Optimierung der Immunantwort bei rezidivierenden Infektionen, insbesondere auch im Harntrakt, stellen die Handlungsalternativen dar, die diesem Ziel eher gerecht werden als der bisher so häufig gehandhabte Focus auf die Antibiotikarezidivprophylaxe.

Auch in Zukunft wird man von Fall zu Fall Antibiotika zur Rezidivprophylaxe bei Harnwegsinfektionen empfehlen. Die Probleme des übermäßigen Gebrauchs von Antibiotika, wie Resistenzentwicklung und nachhaltige Störung der intestinalen Mikrobiota, zwingen aber nach Alternativen zu suchen. Der Einsatz von Probiotika allein oder in Kombination mit Immuntherapeutika bzw. die alleinige Gabe von Immuntherapeutika stellen wichtige Behandlungsoptionen dar, die bereits im klinischen Alltag zur Verfügung stehen. Diese Therapieansätze zielen dabei auf den Pathomechanismus einer Infektion ab und stellen eine kausale Herangehensweise an die Problematik dar. Phytotherapeutika bzw. auch kleine Moleküle wie Mannose, die die Adhärenz der Bakterien am Urothel behindern, sind ergänzende Ansätze.

Empfehlungen in der EAU-Leitlinie zur Langzeitprophylaxe von Harnwegsinfektionen sind: Orale und parenterale Immunstimulantien (StroVac^®), lokale Östrogensubstitution und Gabe von Lactobacillus rhamnosus und Lactobacillus reuteri.

Abstract

The aim of all medical treatment is “primum nihil nocere” (“First, do no harm”).

Restoring the integrity of intestinal microbiota and optimising the immune response in recurrent infections, especially in the urinary tract, are treatment alternatives which are closer to this target than the usual focus on antibiotic prevention of recurrence.

In the future, antibiotics will continue to be recommended for the prevention of urinary tract infections on a case-by-case basis. However, the problems of an excessive use of antibiotics, e. g. resistance and long-term interference with intestinal microbiota, are forcing us to search for alternatives. The use of probiotics alone or in combination with immunotherapeutics, or the sole use of immunotherapeutics, are important treatment options, which are already routinely available in clinical practice. These therapies are focused on the pathomechanism of an infection and tackle the root cause of the problem. Phytotherapeutics or small molecules like mannose, which restricts the adherence of bacteria to the urothelium, are complementary approaches.

The EAU guidelines recommend the following treatments for the long-term prevention of urinary tract infections:

Oral and parenteral immunostimulants (StroVac^®), local estrogen replacement and administration of Lactobacillus rhamnosus and Lactobacillus reuteri.

Schlüsselwörter

Rezidivierender Harnwegsinfekt - Probiotika - Immunstimulantien - Lokale Östrogensubstitution - Cranberry-Extrakt

Key words

recurrent urinary tract infection - probiotics - immunostimulants - local estrogen replacement - cranberry extract

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