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Antibiotika-assoziierte Diarrhoe und Enterocolitis

Antibiotic-associated diarrhoea and enterocolitis

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Summary

Many antibiotics, particularly the lincomycins, may cause diarrhoea with or without enterocolitis. The pathogenesis of antibiotic-associated diarrhoea without colitis is uncertain; colloidosmotic water binding in the colon by endogenous glycoproteins undegraded by colonic bacteria is considered. Antibiotic-associated enterocolitis is now known to be due to toxin-producing clostridia, proven for Cl. difficile. Improved methods for the detection of toxin and clostridia are presently being studied. Endoscopically, pseudomembranes are characteristic but not antibiotic-specific, they may be absent or missed diagnostically. A possible role of asymptomatic clostridiacarriers in enterocolitis clustering remains to be determined. The potentially lethal course of the disease requires rapid diagnosis and therapy, with discontinuation of the antibiotic, intensive supportive measures and, at least in severe disease, oral vancomycin.

Zusammenfassung

Viele Antibiotika, besonders Lincomycine, können Durchfälle mit und ohne Enterocolitis hervorrufen. Die Pathogenese der Diarrhoen ohne Colitis ist ungeklärt; eine kolloidosmotische Wasserbindung im Colon durch bakteriell nicht abgebaute endogene Glykoproteine wird erwogen. Die Ursache der Enterocolitis ist seit zwei Jahren bekannt. Zugrunde liegt eine Proliferation toxinbildender Clostridien im Lumen, erwiesen für Cl. difficile. Verbesserte Nachweismethoden für Toxin und Erreger befinden sich in der Entwicklung. Endoskopisch sind Pseudomembranen charakteristisch, aber nicht antibiotika-spezifisch, sie können fehlen oder der Diagnostik entgehen. Die Inzidenz der Enterocolitis ist auffällig wechselnd, eine Rolle asymptomatischer Clostridienträger möglich. Der potentiell tödliche Verlauf erfordert eine rasche Diagnostik und Therapie, mit Absetzen des Antibiotikums, intensiven unterstützenden Maßnahmen und zumindest in schweren Fällen oralem Vancomycin.

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    K. Loeschke

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Loeschke, K. Antibiotika-assoziierte Diarrhoe und Enterocolitis. Klin Wochenschr 58, 337–345 (1980). https://doi.org/10.1007/BF01477276

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