Bakterielle Konjunktivitis – Update zu Diagnose und Therapie

Zusammenfassung

Die akute bakterielle Konjunktivitis ist ein häufiges Problem sowohl in der Allgemeinarztpraxis als auch beim Ophthalmologen. Die Symptome und klinischen Zeichen erlauben meist eine Diagnose ohne Bindehautabstrich. Mikrobiologische Untersuchungen werden primär bei Neugeborenen, Immunsupprimierten und hyperakuter Konjunktivitis empfohlen. Besorgniserregend ist die zunehmende Isolierung methicillinresistenter Staph. aureus in den letzten Jahren. Studien belegen die schnellere klinische und mikrobielle Remission der bakteriellen Konjunktivitis unter antibiotischer Lokaltherapie. Die zunehmende Resistenzentwicklung der klassischen Konjunktivitiserreger gegenüber allen Antibiotikagruppen ist jedoch alarmierend und sollte das Therapieverhalten beeinflussen. Fluoroquinolone sind in der Therapie der akuten bakteriellen Konjunktivitis sehr gut wirksam, müssen jedoch aufgrund ihres effizienten Wirkspektrums als Reservemedikament in der Therapie der akuten Konjunktivitis gelten. Antibiotika wie Gentamycin, Tobramicin und Azithromycin sollte der Vorzug gegeben werden. Bei hoher Spontanheilungsrate ist auch eine verzögerte Antibiotikagabe bei Persistenz der Beschwerden nach 3 – 4 Tagen bzw. eine Therapie ohne Antibiose mit Tränenersatz und Augenbädern zu erwägen. Eine additive antientzündliche Therapie wird generell nicht empfohlen. Eine chronisch rezidivierende follikuläre Konjunktivitis erfordert einen Chlamydienabstrich und, bei positivem Nachweis, eine systemische Antibiose von Patient und Sexualpartner.

Abstract

Acute bacterial conjunctivitis is a common health-care issue for the general practitioner and the ophthalmologist. Signs and symptoms usually allow a correct diagnosis without conjunctival swab. Primary microbiological investigations are recommended in newborns, immunocompromised patients and cases of hyperacute conjunctivitis. Of concern are methicillin-resistant Staphylococcus aureus strains which have been isolated with increasing frequency in the last few years. Studies have demonstrated the faster clinical and microbiological cure of acute bacterial conjunctivitis with topical antibiotics. However, the development of resistance of the typical germs to all of the antibiotic groups is alarming and should influence therapeutic behaviour. Fluoroquinolones show good activity in the treatment of acute bacterial conjunctivitis but should be saved for severe infections due to its broad spectrum of activity. Antibiotics such as gentamycin, tobramycin, and azithromycin should be preferred. Considering the high spontaneous healing rate of acute conjunctivitis, delayed topical antibiotics in case of persistence after 3 – 4 days, or treatment without antibiotics using artificial tears and eye bathings may be considered. Additive anti-inflammatory drugs are generally not recommended. Chronic-recurrent follicular conjunctivitis necessitates testing for Chlamydia, and in case of a positive result, systemic antibiotic treatment of patient and sexual partner.

Schlüsselwörter

Bindehaut - Infektiologie - Mikrobiologie

Key words

conjunctiva - infectious diseases - microbiology

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