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Medikamentöse Therapie von Harnwegsinfekten

Medical therapy of urinary tract infection

Der Internist volume 49, pages 747–755 (2008)Cite this article

Zusammenfassung

Harnwegsinfektionen gehören zu den häufigsten Infektionen sowohl in der ambulanten als auch in der stationären Patientenbetreuung. Das therapeutische Vorgehen richtet sich nach der Lokalisation der Infektion (untere vs. obere), dem klinischen Bild (akut vs. chronisch), den pathogenetischen Aspekten (unkompliziert vs. kompliziert), dem vermeintlichen oder nachgewiesenen Erreger und dessen lokaler Resistenzsituation sowie anderen Begleitumständen beim Patienten. Das Spektrum der antibiotischen Therapie ist weitgehend durch klinische Studien belegt und reicht von der oralen Monokurzzeit- bis zur parenteralen Kombinationstherapie über 7–14 Tage, u. U. auch länger. Hinzu kommen Maßnahmen der Prävention bzw. der Rezidivprophylaxe. In der experimentellen wie klinischen Forschung wird nach neuen Möglichkeiten wie Vakzination, Immunmodulation u. a. gesucht. Im konkreten Krankheitsfall sollte der behandelnde Arzt unter Beachtung der Empfehlungen, in Abwägung der Risiken und unter Einbeziehung aller Faktoren eine rationale, erregerbezogene Therapie durchführen, die eine rasche Symptomfreiheit, möglichst eine Eradikation erzielt und ökonomisch vertretbar ist.

Abstract

Urinary tract infections (UTI) are the most common bacterial infectious diseases seen in the community, in most cases caused by E. coli. The treatment strategy differs depending on localization (lower vs. upper UT), acute uncomplicated vs. complicated infection, as well as for chronic disease and asymptomatic bacteriuria, the known or susceptible causative uropathogen with the (local) resistance pattern and the morbidity of the patient. There is a considerable worrying increase in the resistance rate of E. coli to TMP/SMX, quinolones and others. Most patients with uncomplicated, in the community acquired UTI are treated safely and effectively as out-patients. The available data support a short-course therapy with 3 days as the current standard therapy for lower UTI, but with a 7–14 days treatment for upper and complicated UTI. Recurrent UTI is best managed by low-dose antimicrobial prophylaxis for 3–6 (12 ore more) months. Besides that, new approaches to preventive strategies must prove their value in specific patient groups.

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Affiliations

  1. Klinikum der Friedrich-Schiller-Universität, Erlanger Allee 101, 07740, Jena, Deutschland

    G. Stein

  2. Klinik für Innere Medizin I, Sophien- und Hufelandklinikum Weimar, Weimar, Deutschland

    R. Fünfstück

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  1. G. Stein
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  2. R. Fünfstück
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Stein, G., Fünfstück, R. Medikamentöse Therapie von Harnwegsinfekten. Internist 49, 747–755 (2008). https://doi.org/10.1007/s00108-008-2036-9

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Schlüsselwörter

  • Harnwegsinfektion
  • Resistenz
  • Uropathogene
  • Antibiotische Therapie

Keywords

  • Urinary tract infection
  • Resistance
  • Uropathogens
  • Antibiotic therapy