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Infektionen der tiefen Atemwege in der Allgemeinpraxis

Lower respiratory tract infections in general practice

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Zusammenfassung

Haemophilus influenzae undStreptococcus pneumoniae werden bei 87% der Exazerbationen bei chronisch-obstruktiver Bronchialerkrankung nachgewiesen. Komplikationen bei viralen Atemwegserkrankungen werden am häufigsten durchH. influenzae ausgelöst. Nicht nur bekapselte Formen vonH. influenzae, sondern auch kapsellose Stämme können für die auftretende Pneumonie und akute Exazerbationen der chronischen Bronchitis bei Erwachsenen verantwortlich sein. Bei Infektionen mitH. influenzae beobachtet man als häufigste Symptome Husten, Dyspnoe, eine stärkere Purulenz des Sputums und pfeifende Rhonchi. Für die Diagnostik wird eine quantitative Sputumkultur empfohlen. Akute Exazerbationen bei chronischer Bronchitis werden stets mit Antibiotika behandelt, die gegenH. influenzae und Pneumokokken wirksam sind. In der Allgemeinpraxis muß in der Regel die empirische Therapie ausreichen. Im Vergleich zwischen drei klassischen Therapien mit Ampicillin, Co-trimoxazol und Cephaclor* schnitt im angeführten Studienprotokoll sowohl bei der empirischen Behandlung als auch bei der gezielten Behandlung Cephaclor am besten ab. Es wird empfohlen, Cephaclor als Antibiotikum der ersten Wahl bei diesen Erkrankungen einzusetzen.

Summary

Haemophilus influenzae andStreptococcus pneumoniae are found in 87% of all cases of exacerbated chronic obstructive bronchopulmonary disease. Complications of viral respiratory tract disease are most frequently caused byH. influenzae. Not only encapsulated forms ofH. influenzae, but also non-encapsulated strains may be responsible for the onset of pneumonia and acute exacerbations of chronic bronchitis in adults. The most common symptoms of infections withH. influenzae are cough, dyspnoea, increase in purulent sputum and wheezing. A quantitative sputum culture is recommended for diagnosing chronic obstructive bronchopulmonary disease. Acute exacerbations of chronic bronchitis are always treated with antibiotics effective againstH. influenzae and pneumococci. As a rule, empirical treatment should suffice in general practice. In the comparison between ampicillin, co-trimoxazole and cefaclor included in the study protocol appended to this report, the latter produced the most favourable results both in the empirical and specific forms of treatment. We would recommend cefaclor as the antibiotic of choice for this disease.

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Cazzola, M. Infektionen der tiefen Atemwege in der Allgemeinpraxis. Infection 15, S113–S119 (1987). https://doi.org/10.1007/BF01650653

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