Verkürzte Therapiedauer bei bakteriellen Infektionen

 

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Pyelonephritis Eine Therapiedauer von 7 Tagen ist bei Patienten mit Pyelonephritis nach neueren Studien sicher und in der Regel ausreichend – auch, wenn anstelle eines Fluorchinolons in der gezielten Behandlung Cotrimoxazol (bei nachgewiesener In-vitro-Aktivität) verwendet wird.

Bauchrauminfektionen Die Therapiedauer bei vielen intraabdominellen Infektionen kann bei entsprechenden Patienten postoperativ bzw. nach adäquater Drainage kurz sein. Vor allem bei Cholezystektomie braucht es in der Regel keine postoperative Antibiotikatherapie.

Gram-negative Bakteriämie/Sepsis Die Therapiedauer bei Gram-negativer Bakteriämie/Sepsis kann bei gutem Ansprechen individuell bis auf 7 Tage (ggf. bei z. B. erfolgter Herdsanierung/Drainage auch kürzer) verkürzt werden. Klinische Kriterien zur Therapiedauersteuerung reichen meist aus.

Ambulant erworbene Pneumonie Die Therapiedauer kann bei Patienten mit ambulant erworbener Pneumonie und gutem Ansprechen nach 3 – 5 Tagen entsprechend kurz sein.

Fieber (unklarer Ursache) und Neutropenie Daten aus einer randomisierten klinischen Studie und weitere Beobachtungen weisen darauf hin, dass bei Fieber unklarer Ursache im Falle von Ansprechen nach empirischer Antibiotikagabe Kurzzeittherapien auch bei Hochrisikopatienten mit Neutropenie adäquat sein können.

Abstract

The adequate duration of antibiotic therapy in the treatment of bacterial infections is often unclear. For many indications guidelines recommend intervals with ranges of several days instead of fixed courses of treatment, and physicians tend to choose longer rather than shorter durations. The emergence of infections due to multidrug-resistant bacteria and the valuation of avoidable side effects from antibiotic agents raised the question whether a shortened duration of therapy is appropriate in specific indications. Therefore clinical trials to investigate the effectiveness of shorter in comparison to prolonged antibiotic treatment have yet been of growing interest to current research. Recent studies have shown that, concerning clinical endpoints, shorter duration of antibiotic therapy is not inferior to longer treatment in the management of pyelonephritis, intraabdominal infections, community acquired pneumonia an also gramnegative bloodstream infections and febrile neutropenia.

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