RSS-Feed abonnieren
DOI: 10.1055/s-2008-1038139
Therapie der ambulant erworbenen Pneumonie
Therapy of Community Acquired PneumoniaPublikationsverlauf
Publikationsdatum:
07. Juli 2008 (online)

Zusammenfassung
Die ambulant erworbene Pneumonie ist die wichtigste Infektionskrankheit in Deutschland und damit ein bedeutender Faktor im Gesundheitswesen. Da zu Beginn der Erkrankung der Erreger meist nicht bekannt ist, kann initial nur empirisch therapiert werden. Eine frühzeitige Diagnosesicherung, gefolgt von einer adäquaten Therapie, bessert die Prognose des Patienten.
Variablen für die Auswahl des Antibiotikums sind Schwere der Erkrankung, Pathogenität des Erregers, Alter und Begleiterkrankungen des Patienten, Ort der Behandlung sowie Art und Zahl antibiotischer Vortherapien. Im Hinblick auf eine Antibiotikaresistenz wurden steigende Resistenzraten von S. pneumoniae gegenüber Makrolidantibiotika in Deutschland beobachtet. Mithilfe einfacher Scores ist eine zuverlässige Unterscheidung von Patienten mit niedrigem und hohem Letalitätsrisiko möglich. Entsprechend ist eine risikoadaptierte Therapie, bei der eine Monotherapie mit klassischen Beta-Laktam-Antibiotika für Patienten mit geringem Risiko einer breiter wirksamen Kombinationstherapie in der Hochrisikogruppe gegenübersteht, sinnvoll. Der Artikel gibt einen Überblick über die wichtigsten Empfehlungen der deutschen Leitlinie und diskutiert neue Erkenntnisse der letzten Jahre.
Literatur
- 1 Bundesgeschäftsstelle für Qualitätssicherung .BQS Qualitätsreport 2005. 2006: 18-27
MissingFormLabel
- 2
Mandell L A.
Epidemiology and etiology of community-acquired pneumonia.
Infect Dis Clin North Am.
2004;
18 (4)
761-76, vii
MissingFormLabel
- 3
Dalhoff K, Marxsen J, Steinhoff J.
[Pneumonias and immunosuppression].
Internist (Berl).
2007;
48 (5)
507-508
MissingFormLabel
- 4
Craven D E.
What is healthcare-associated pneumonia, and how should it be treated?.
Curr Opin Infect Dis.
2006;
19 (2)
153-160
MissingFormLabel
- 5
Klevens R M, Morrison M A, Nadle J. et al .
Invasive methicillin-resistant Staphylococcus aureus infections in the United States.
JAMA.
2007;
298
1763-1771
MissingFormLabel
- 6
Lonks J R, Garau J, Medeiros A A.
Implications of antimicrobial resistance in the empirical treatment of community-acquired
respiratory tract infections: the case of macrolides.
J Antimicrob Chemother.
2002;
50 Suppl S2
87-92
MissingFormLabel
- 7
Paterson D L.
“Collateral damage” from cephalosporin or quinolone antibiotic therapy.
Clin Infect Dis.
2004;
38 Suppl 4
S341-S345
MissingFormLabel
- 8
Schrag S J, McGee L, Whitney C G. et al .
Emergence of Streptococcus pneumoniae with very-high-level resistance to penicillin.
Antimicrob Agents Chemother.
2004;
48 (8)
3016-3023
MissingFormLabel
- 9
Yu V L, Baddour L M.
Infection by drug-resistant Streptococcus pneumoniae is not linked to increased mortality.
Clin Infect Dis.
2004;
39
1086-1087
MissingFormLabel
- 10
Aspa J, Rajas O, Rodriguez D C. et al .
Impact of initial antibiotic choice on mortality from pneumococcal pneumonia.
Eur Respir J.
2006;
27
1010-1019
MissingFormLabel
- 11
Song J H, Jung S I, Ki H K. et al .
Clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains
in asian countries: a study by the Asian Network for Surveillance of Resistant Pathogens.
Clin Infect Dis.
2004;
38
1570-1578
MissingFormLabel
- 12
Fuller J D, Low D E.
A review of Streptococcus pneumoniae infection treatment failures associated with
fluoroquinolone resistance.
Clin Infect Dis.
2005;
41
118-121
MissingFormLabel
- 13
Bauer T T, Ewig S, Marre R. et al .
CRB-65 predicts death from community-acquired pneumonia.
J Intern Med.
2006;
260
93-101
MissingFormLabel
- 14
Capelastegui A, Espana P P, Quintana J M. et al .
Validation of a predictive rule for the management of community-acquired pneumonia.
Eur Respir J.
2006;
27
151-157
MissingFormLabel
- 15
Falagas M E, Siempos I I, Bliziotis I A. et al .
Impact of initial discordant treatment with beta-lactam antibiotics on clinical outcomes
in adults with pneumococcal pneumonia: a systematic review.
Mayo Clin Proc.
2006;
81 (12)
1567-1574
MissingFormLabel
- 16
Petitpretz P, Arvis P, Marel M. et al .
Oral moxifloxacin vs high-dosage amoxicillin in the treatment of mild-to-moderate,
community-acquired, suspected pneumococcal pneumonia in adults.
Chest.
2001;
119
185-195
MissingFormLabel
- 17
Hoffken G, Lorenz J, Kern W. et al .
[S3-guideline on ambulant acquired pneumonia and deep airway infections].
Pneumologie.
2005;
59
612-664
MissingFormLabel
- 18
Vanderkooi O G, Low D E, Green K. et al .
A. Predicting antimicrobial resistance in invasive pneumococcal infections.
Clin Infect Dis.
2005;
40
1288-1297
MissingFormLabel
- 19
Baddour L M, Yu V L, Klugman K P. et al .
Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal
bacteremia.
Am J Respir Crit Care Med.
2004;
170
440-444
MissingFormLabel
- 20
Paul M, Nielsen A D, Gafter-Gvili A. et al .
The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis.
Eur Respir J.
2007;
30
525-531
MissingFormLabel
- 21
Anderson K B, Tan J S, File T M. et al .
Emergence of levofloxacin-resistant pneumococci in immunocompromised adults after
therapy for community-acquired pneumonia.
Clin Infect Dis.
2003;
37
376-381
MissingFormLabel
- 22
Davidson R, Cavalcanti R, Brunton J L. et al .
Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia.
N Engl J Med.
2002;
346
747-750
MissingFormLabel
- 23
Leroy O, Devos P, Guery B. et al .
Simplified prediction rule for prognosis of patients with severe community-acquired
pneumonia in ICUs.
Chest.
1999;
116
157-165
MissingFormLabel
- 24
Finch R, Schurmann D, Collins O. et al .
Randomized controlled trial of sequential intravenous (i. v.) and oral moxifloxacin
compared with sequential i. v. and oral co-amoxiclav with or without clarithromycin
in patients with community-acquired pneumonia requiring initial parenteral treatment.
Antimicrob Agents Chemother.
2002;
46
1746-1754
MissingFormLabel
- 25
Correa J C, Badaro R, Bumroongkit C. et al .
Randomized, open-label, parallel-group, multicenter study of the efficacy and tolerability
of IV gatifloxacin with the option for oral stepdown gatifloxacin versus IV ceftriaxone
(with or without erythromycin or clarithromycin) with the option for oral stepdown
clarithromycin for treatment of patients with mild to moderate community-acquired
pneumonia requiring hospitalization.
Clin Ther.
2003;
25
1453-1468
MissingFormLabel
- 26
Witte W, Strommenger B, Cuny C. et al .
Methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leucocidin
gene in Germany in 2005 and 2006.
J Antimicrob Chemother.
2007;
60
1258-1263
MissingFormLabel
- 27
Witte W, Cuny C, Strommenger B. et al .
Emergence of a new community acquired MRSA strain in Germany.
Euro Surveill.
2004;
9
16-18
MissingFormLabel
- 28
Fink M P, Snydman D R, Niederman M S. et al .
Treatment of severe pneumonia in hospitalized patients: results of a multicenter,
randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin.
The Severe Pneumonia Study Group.
Antimicrob Agents Chemother.
1994;
38
547-557
MissingFormLabel
- 29
Chastre J.
Antimicrobial treatment of hospital-acquired pneumonia.
Infect Dis Clin North Am.
2003;
17 (4)
727-737, vi
MissingFormLabel
- 30
Yu V L, Chiou C C, Feldman C. et al .
An international prospective study of pneumococcal bacteremia: correlation with in
vitro resistance, antibiotics administered, and clinical outcome.
Clin Infect Dis.
2003;
37
230-237
MissingFormLabel
- 31
Meehan T P, Chua-Reyes J M, Tate J. et al .
Process of care performance, patient characteristics, and outcomes in elderly patients
hospitalized with community-acquired or nursing home-acquired pneumonia.
Chest.
2000;
117
1378-1385
MissingFormLabel
- 32
Houck P M, MacLehose R F, Niederman M S. et al .
Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10
western states: 1993, 1995, and 1997.
Chest.
2001;
119 (5)
1420-1426
MissingFormLabel
- 33
Oosterheert J J, Bonten M J, Schneider M M. et al .
Effectiveness of early switch from intravenous to oral antibiotics in severe community
acquired pneumonia: multicentre randomised trial.
BMJ.
2006;
333
1193
MissingFormLabel
- 34
Dunbar L M, Wunderink R G, Habib M P. et al .
High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment
paradigm.
Clin Infect Dis.
2003;
37
752-760
MissingFormLabel
- 35
el Moussaoui R, de Borgie C A, van den Broek B P. et al .
Effectiveness of discontinuing antibiotic treatment after three days versus eight
days in mild to moderate-severe community acquired pneumonia: randomised, double blind
study.
BMJ.
2006;
332
1355
MissingFormLabel
- 36
Fein A M, Feinsilver S H, Niederman M S. et al .
“When the pneumonia doesn't get better”.
Clin Chest Med.
1987;
8
529-541
MissingFormLabel
- 37
Arancibia F, Ewig S, Martinez J A. et al .
Antimicrobial treatment failures in patients with community-acquired pneumonia: causes
and prognostic implications.
Am J Respir Crit Care Med.
2000;
162
154-160
MissingFormLabel
PD Dr. med. Bernhard Schaaf
Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
Ratzeburger Allee 160
23538 Lübeck
eMail: schaaf@uni-luebeck.de