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Antibiotikatherapie: Wirkung und Resistenz

Antibiotic therapy: impact and resistance

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Viele Fortschritte der modernen Medizin, wie beispielsweise auf den Gebieten der Transplantationsmedizin, Onkologie, Chirurgie und Intensivmedizin, wären ohne die effiziente Behandlung bakterieller Infektionen nicht möglich gewesen. Andererseits sind multiresistente Erreger weltweit auf dem Vormarsch. Die Gründe dafür sind komplex und vielfältig.

Ziel der Arbeit

Die Vermittlung der Kenntnisse über Wirkung und Resistenzmechanismen von Antibiotika, die Grundpfeiler der kalkulierten und gezielten antiinfektiven Therapie sind, steht im Vordergrund.

Ergebnisse

Der Übersichtsartikel behandelt die Wirkung der gängigen Antibiotika in der Notfall- und Intensivmedizin. Häufige resistente Erreger aus dem klinischen Alltag werden beschrieben sowie deren Resistenzmechanismen dargestellt. Reserveantibiotika, die bei schwerwiegenden Infektionen eingesetzt werden, werden beleuchtet.

Schlussfolgerungen

Für eine erfolgreiche Antibiotikatherapie sowie zur Reduktion resistenter Erreger sind Kenntnisse über Wirkungsweise und Wirkspektrum der Substanzen integrale Bestandteile.

Abstract

Background

Many achievements in modern medicine, such as in transplantation medicine, cancer therapy, surgery, and intensive care medicine would have been impossible without effective treatment of bacterial infections. Antibiotic resistance is on the rise; the reasons for this are complex and vary greatly.

Objective

Knowledge about the impact of antibiotics and mechanisms of antibiotic resistance, which are the cornerstones of calculated and targeted antibiotic therapy, is imperative.

Results

This review describes the pharmacodynamics of relevant antibiotics in emergency and intensive care medicine. Commonly resistant bacteria with clinical relevance and the respective mechanisms of resistance are highlighted. Furthermore, the use of antiinfectives for reserve treatment of severe infections is discussed.

Conclusion

Understanding the mechanisms of resistance and effects of antibiotics are fundamental for efficient and successful treatment of bacterial infections and for the reduction of resistant species.

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Literatur

  1. Allington DR, Rivey MP (2001) Quinupristin/dalfopristin: a therapeutic review. Clin Ther 23:24–44

    Article  CAS  PubMed  Google Scholar 

  2. Asbel LE, Levison ME (2000) Cephalosporins, carbapenems, and monobactams. Infect Dis Clin North Am 14:435–447

    Article  CAS  PubMed  Google Scholar 

  3. Baddour LM, Yu VL, Klugman KP et al (2004) Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 170:440–444

    Article  PubMed  Google Scholar 

  4. Bain KT, Wittbrodt ET (2001) Linezolid for the treatment of resistant gram-positive cocci. Ann Pharmacother 35:566–575

    Article  CAS  PubMed  Google Scholar 

  5. Cha R, Grucz RG Jr, Rybak MJ (2003) Daptomycin dose-effect relationship against resistant gram-positive organisms. Antimicrob Agents Chemother 47:1598–1603

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Edwards DI (1993) Nitroimidazole drugs–action and resistance mechanisms. I. Mechanisms of action. J Antimicrob Chemother 31:9–20

    Article  CAS  PubMed  Google Scholar 

  7. Gilbert DN, Moellering RC, Eliopoulos GM et al (2010) Comparison of antibacterial spectra. In: The Sanford Guide to Antimicrobial Therapy, Antimicrobial Therapy Inc, Sperryville, S 66–71

  8. Gleckman R, Blagg N, Joubert DW (1981) Trimethoprim: mechanisms of action, antimicrobial activity, bacterial resistance, pharmacokinetics, adverse reactions, and therapeutic indications. Pharmacotherapy 1:14–20

    CAS  PubMed  Google Scholar 

  9. Gold HS, Moellering RC Jr (1996) Antimicrobial-drug resistance. N Engl J Med 335: 1445–1453

    Article  CAS  PubMed  Google Scholar 

  10. Hooper DC (1999) Mechanisms of fluoroquinolone resistance. Drug Resist Updat 2:38–55

    Article  CAS  PubMed  Google Scholar 

  11. http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=444. Zugegriffen: 06. Dezember 2013

  12. http://www.ema.europa.eu. Zugegriffen: 24. Dezember 2013

  13. http://www.imi.europa.eu/content/8th-call-2012. Zugegriffen: 06. Januar 2014

  14. Infectious Diseases Society of America (2010) The 10 × ‚20 initiative: pursuing a global commitment to develop 10 new antibacterial drugs by 2020. Clin Infect Dis 50:1081–1083

    Article  Google Scholar 

  15. Kumana CR, Yuen KY (1994) Parenteral aminoglycoside therapy. Selection, administration and monitoring. Drugs 47:902–913

    Article  CAS  PubMed  Google Scholar 

  16. Kumarasamy KK, Toleman MA, Walsh TR et al (2010) Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 10:597–602

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Leung E, Weil DE, Raviglione M et al (2011) The WHO policy package to combat antimicrobial resistance. Bull World Health Organ 89:390–392

    Article  PubMed Central  PubMed  Google Scholar 

  18. Patel SS, Balfour JA, Bryson HM (1997) Fosfomycin tromethamine. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy as a single-dose oral treatment for acute uncomplicated lower urinary tract infections. Drugs 53:637–656

    Article  CAS  PubMed  Google Scholar 

  19. Paterson DL, Bonomo RA (2005) Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 18: 657–686

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Paul M, Benuri-Silbiger I, Soares-Weiser K et al (2004) Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. BMJ 328:668

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Rapp RP, McCraney SA, Goodman NL et al (1994) New macrolide antibiotics: usefulness in infections caused by mycobacteria other than Mycobacterium tuberculosis. Ann Pharmacother 28: 1255–1263

    CAS  PubMed  Google Scholar 

  22. Roberts MC (2003) Tetracycline therapy: update. Clin Infect Dis 36: 462–467

    Article  CAS  PubMed  Google Scholar 

  23. Tamma PD, Cosgrove SE, Maragakis LL (2012) Combination therapy for treatment of infections with gram-negative bacteria. Clin Microbiol Rev 25: 450–470

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Sabath LD (1989) Reappraisal of the antistaphylococcal activities of first-generation (narrow-spectrum) and second-generation (expanded-spectrum) cephalosporins. Antimicrob Agents Chemother 33: 407–411

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Safdar N, Handelsman J, Maki DG (2004) Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 4: 519–527

    Article  PubMed  Google Scholar 

  26. Stein GE, Craig WA (2006) Tigecycline: a critical analysis. Clin Infect Dis 43:518–524

    Article  CAS  PubMed  Google Scholar 

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Danksagung

Die Autoren danken Herrn Mag. pharm. P. Weiler für die Unterstützung bei der Korrektur des Manuskripts.

Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Weiler und N. Corti geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Klinische Pharmakologie und Toxikologie, Universitätsspital Zürich, 8091, Zürich, Schweiz

    S. Weiler PhD & N. Corti

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  1. S. Weiler PhD
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  2. N. Corti
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Correspondence to S. Weiler PhD.

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Weiler, S., Corti, N. Antibiotikatherapie: Wirkung und Resistenz. Med Klin Intensivmed Notfmed 109, 167–174 (2014). https://doi.org/10.1007/s00063-013-0307-2

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