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Empirische Antibiotikatherapie in der Notaufnahme

Empirical antibiotic therapy in the emergency department

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Zusammenfassung

Aufgrund der Häufigkeit von Infektionserkrankungen sind Antibiotika in der Notaufnahme wichtige und oft lebensrettende Medikamente, andererseits fallen Therapieentscheidungen oft unter einem besonderen Druck. In der Praxis findet sich ein hoher Anteil nichtadäquater Antibiotikaverschreibungen, obwohl bereits in der Notaufnahme hinsichtlich einer adäquaten antibiotischen Therapie wichtige Weichen gestellt werden. Zur Auswahl einer sinnvollen Antibiotikastrategie müssen in der Notaufnahme akut lebensbedrohliche Infektionen (Diagnostik und umgehende empirische Therapie) von unkomplizierteren Infektionserkrankungen (keine/wenig Diagnostik, empirische Therapie) und komplexeren Infektionen eher chronischer Natur (adäquate Diagnostik, keine/späte Therapie) unterschieden werden. Der Beitrag gibt außerdem einen Überblick zu allgemein wichtigen Punkten der Antibiotikatherapie in der Notaufnahme sowie zur speziellen Antibiotikatherapie der wichtigsten Erkrankungen.

Abstract

Due to the frequency of infectious diseases, antibiotic drugs are important and frequently life-saving medications in the emergency department (ED). On the other hand, rapid treatment decisions have to be made and a significant proportion of inadequate antibiotic prescriptions are observed in clinical practice although decisions in the ED set the course for adequate antibiotic treatment. In order to choose an appropriate treatment strategy, acute life-threatening infections (diagnostics and immediate empirical therapy) have to be differentiated in the ED from less complicated infections (mainly empirical therapy) and complicated infections of a frequently chronic nature (adequate diagnostics, no or delayed therapy). Additionally, this article gives a review of important general aspects of antibiotic therapy in the ED as well as the specific therapy of the most important infectious diseases.

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Literatur

  1. van de Beek D, Cabellos C, Dzupova O et al (2016) ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 22(Suppl 3):S37–S62. doi:10.1016/j.cmi.2016.01.007

    Article  PubMed  Google Scholar 

  2. Borde JP, Kern WV, Hug M et al (2015) Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department. Emerg Med J 32:509–515. doi:10.1136/emermed-2014-204067

    Article  PubMed  Google Scholar 

  3. Brouwer MC, McIntyre P, Prasad K, van de Beek D (2015) Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 9:CD004405. doi:10.1002/14651858.CD004405.pub5

    Google Scholar 

  4. CDC (2011) National Hospital Ambulatory Medical Care Survey : 2011 Emergency Department Summary Tables. https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf. Zugegriffen: 1.12.2016

  5. CDC Office of Infectious Diseases, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention (2013) Antibiotic resistance threats in the United States, 2013

    Google Scholar 

  6. Dellinger R, Levy M, Rhodes A (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med 41:580–637. doi:10.1097/CCM.0b013e31827e83af

    Article  PubMed  Google Scholar 

  7. Donnelly JP, Baddley JW, Wang HE (2014) Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother 58:1451–1457. doi:10.1128/AAC.02039-13

    Article  PubMed  PubMed Central  Google Scholar 

  8. DuPont HL (2014) Acute infectious diarrhea in immunocompetent adults. N Engl J Med 370:1532–1540. doi:10.1056/NEJMra1301069

    Article  CAS  PubMed  Google Scholar 

  9. Ewig S, Höffken G, Kern W V et al (2015) S3-Leitlinie Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2015.

  10. Fleischmann C, Thomas-Rueddel DO, Hartmann M et al (2016) Fallzahlen und Sterblichkeitsraten von Sepsis-Patienten im Krankenhaus. Dtsch Arztebl Int 113:159–166. doi:10.3238/arztebl.2016.0159

    PubMed  PubMed Central  Google Scholar 

  11. Fleming-Dutra KE, Hersh AL, Shapiro DJ et al (2016) Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 315:1864. doi:10.1001/jama.2016.4151

    Article  CAS  PubMed  Google Scholar 

  12. H. Wächtler, J.-F. Chenot, G. Schmiemann AA (2009) Halsschmerzen DEGAM-Leitlinie Nr. 14.

  13. Habib G, Lancellotti P, Antunes MJ et al (2015) 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J 36:ehv319

    Article  Google Scholar 

  14. Hagel S, Epple H‑J, Feurle GE et al (2015) S2k-Leitlinie Gastrointestinale Infektionen und Morbus Whipple. Z Gastroenterol 53:418–459. doi:10.1055/s-0034-1399337

    Article  CAS  PubMed  Google Scholar 

  15. Höffken G, Lorenz J, Kern W et al (2010) Guidelines of the Paul-Ehrlich-Society of Chemotherapy, the German Respiratory Diseases Society, the German Infectious Diseases Society and of the Competence Network CAPNETZ for the Management of Lower Respiratory Tract Infections and Community-acquired P. Pneumologie 64:149–154. doi:10.1055/s-0029-1243910

    Article  PubMed  Google Scholar 

  16. Hooton TM (2012) Uncomplicated urinary tract infection. N Engl J Med 366:1028–1037. doi:10.1056/NEJMcp1104429

    Article  CAS  PubMed  Google Scholar 

  17. Lipsky BA, Berendt AR, Cornia PB et al (2012) 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54:e132–e173. doi:10.1093/cid/cis346

    Article  PubMed  Google Scholar 

  18. May L, Cosgrove S, L’Archeveque M et al (2013) A call to action for antimicrobial stewardship in the emergency department: Approaches and strategies. Ann Emerg Med 62:69–77.e2. doi:10.1016/j.annemergmed.2012.09.002

    Article  PubMed  Google Scholar 

  19. Mühlenfeld M, Beyer M, Wagner H‑O (2014) S2k-Leitlinie Ohrenschmerzen.

  20. Pfister H‑W, et al. (2015) S2k-Leitlinie Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter.

  21. Schöfer H, Bruns R, Effendy I et al (2011) Diagnosis and treatment of staphylococcus aureus infections of the skin and mucous membranes. J Dtsch Dermatol Ges 9:953–967. doi:10.1111/j.1610-0387.2011.07786.x

    PubMed  Google Scholar 

  22. Schuetz P, Christ-Crain M, Thomann R et al (2009) Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 302:1059–1066. doi:10.1001/jama.2009.1297

    Article  CAS  PubMed  Google Scholar 

  23. Shehab N, Patel PR, Srinivasan A, Budnitz DS (2008) Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 47:735–743. doi:10.1086/591126

    Article  PubMed  Google Scholar 

  24. Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810. doi:10.1001/jama.2016.0287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 50:133–164. doi:10.1086/649554

    Article  PubMed  Google Scholar 

  26. Stevens DL, Bisno AL, Chambers HF et al (2014) Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 59:147–159. doi:10.1093/cid/ciu296

    Article  PubMed  Google Scholar 

  27. Trinh TD, Klinker KP (2015) Antimicrobial stewardship in the emergency department. Infect Dis Ther 4:39–50

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wagenlehner F, Schmiemann G, Hoyme U et al (2010) S‑3 Leitlinie Epidemiologie, Diagnostik, Therapie und Management unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. AWMF

  29. Wessels MR (2011) Streptococcal Pharyngitis. N Engl J Med 364:648–655. doi:10.1056/NEJMcp1009126

    Article  CAS  PubMed  Google Scholar 

  30. de With K, Franz Allerberger U‑P, Amann S et al (2013) S3-Leitlinie Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus.

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Authors and Affiliations

  1. Stabsstelle Infektiologie, Universitätsklinikum Regensburg, Regensburg, 93043, Deutschland

    F. Hitzenbichler,  B. Salzberger &  F. Hanses

  2. Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, 93043, Regensburg, Deutschland

    M. Zimmermann &  F. Hanses

Authors
  1. F. Hitzenbichler
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  2. B. Salzberger
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  3. M. Zimmermann
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  4. F. Hanses
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Correspondence to F. Hanses.

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Interessenkonflikt

F. Hitzenbichler, B. Salzberger, M. Zimmermann und F. Hanses geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Dodt, München

C. Wrede, Berlin

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Hitzenbichler, F., Salzberger, B., Zimmermann, M. et al. Empirische Antibiotikatherapie in der Notaufnahme. Notfall Rettungsmed 20, 190–198 (2017). https://doi.org/10.1007/s10049-016-0251-9

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  • DOI: https://doi.org/10.1007/s10049-016-0251-9

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