Der Internist

, Volume 47, Issue 9, pp 908–916

Antibiotikatherapie bei Exazerbation

Schwerpunkt: COPD
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Zusammenfassung

Bakterielle Infektionen sind bei etwa der Hälfte der akuten Exazerbationen der COPD beteiligt. Pneumokokken, Hämophilus influenzae und Moraxella catarrhalis spielen hierbei die Hauptrolle. Studien mit Erregerquantifizierung bzw. molekularer Charakterisierung der Erregerstämme sprechen für eine kausale Bedeutung der bakteriellen Infektion. Longitudinale Vergleiche von symptomfreien Phasen und akuten Episoden zeigten eine Assoziation von Infektion und bronchialer Inflammation. Im Gegensatz zur Glukokortikoidtherapie und der nichtinvasiven Beatmung ist die Gabe von Antibiotika in der akuten Exazerbation nicht gut etabliert. Aktuelle Leitlinien empfehlen eine antimikrobielle Therapie bei Typ-I-Exazerbationen nach Anthonisen, bei beatmungspflichtigen Patienten und relevanter kardialer Komorbidität. Die lokale Eradikation der Bakterien sollte angestrebt werden, da dies das Intervall zur nächsten Exazerbation verlängert.

Schlüsselwörter

COPD Infektexazerbation Bronchiale Inflammation Antibiotikatherapie Bakterieneradikation 

Antibiotic therapy for exacerbation

Abstract

Bacterial infections are involved in approximately 50% of acute exacerbations of chronic bronchitis (AECB). Pneumococci, Haemophilus influenzae and Moraxella catarrhalis are the main pathogens. Studies using quantitative cultures and molecular typing suggest a causal relationship between bacterial infection and exacerbation. Furthermore, an association between infection and bronchial inflammation has been demonstrated. In contrast to steroid therapy and non-invasive ventilation, the benefits of antibiotic treatment are not well established. Current guidelines recommend antimicrobial therapy for AECB in type I exacerbations, for patients needing ventilatory support and for patients with cardiac comorbidity. Bacterial eradication is able to prolong the infection free interval.

Keywords

COPD AECB Bronchial inflammation Antimicrobial therapy Bacterial eradication 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Medizinische Klinik IIIUniversitätsklinikum Schleswig-Holstein – Campus LübeckLübeck

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