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Prophylaxe und Behandlung von Infektionen beim älteren Rheumapatienten

Prophylaxis and treatment of infections in elderly patients with rheumatism

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Zusammenfassung

Das Risiko an einer schweren Infektion zu erkranken steigt mit zunehmendem Alter. Dies liegt im Wesentlichen an der Immunoseneszenz und den mit dem Alter zunehmenden Komorbiditäten. Besonders kritisch ist die Situation, wenn ältere Patienten aufgrund des Vorliegens einer rheumatologischen Grunderkrankung mit einer immunsuppressiven Therapie behandelt werden oder eine solche erforderlich wird. Hier gilt es bei der Auswahl der zum Einsatz kommenden Substanzen besonders sorgfältig abzuwägen. Noch wichtiger als bei jungen ist es bei älteren Patienten mit Glukokortikoiden möglichst kurz und niedrig dosiert zu therapieren. Durch Impfungen gegen Influenza und Pneumokokken kann ein großer Teil der Infektionen vermieden werden. Kommt es zum Auftreten einer Infektion, sollten Antibiotika konsequent und möglichst gemäß Antibiogramm eingesetzt werden. Gerade bei älteren Betroffenen gilt es, Nutzen und mögliche Nebenwirkungen einer medikamentösen Therapie besonders sorgfältig abzuwägen und mögliche Wechselwirkungen zu beachten. Dies setzt eine Erfassung des Gesundheitszustands im Ganzen voraus.

Abstract

In general, the risk of serious infections increases with age, mainly explained by immunosenescence and accumulation of comorbidities. Those patients with rheumatoid arthritis who are of advanced age and require treatment with immunosuppressive agents are at particular risk to develop an infectious disease. Actual requirement and kind of treatment on the one hand, and risk of infection on the other hand, have to be considered carefully for each patient. For example, in high-risk patients, it is important to use glucocorticoids in a minimal way, i.e. in low doses and as short as possible. Vaccination, especially against influenza and pneumococci, plays an essential role in preventing infectious diseases, particularly in the elderly. Nevertheless, in cases of suspected bacterial infection, empiric antibiotic therapy should be started promptly. Due to the burden of drugs taken by patients of advanced age, the benefits and possible side effects as well as potential drug interactions have to be carefully considered. In summary, drug treatment of the elderly requires bearing in mind the complete health status of the individual patient.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Die Autoren weisen auf folgende Beziehungen hin: A. Strangfeld: Vortragshonorare von Pfizer, BMS, MSD, UCB, Abbvie und Roche. K. Krüger: Vorträge und/oder Beratung bei Abbvie, BMS, Medac, MSD, Pfizer, Roche und UCB. C. Kneitz: Vorträge und/oder Beratung bei Abbvie, Berlin-Chemie, Chugai, Roche, MSD, Pfizer, BMS und UCB. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. C. Kneitz.

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Kneitz, C., Strangfeld, A. & Krüger, K. Prophylaxe und Behandlung von Infektionen beim älteren Rheumapatienten. Z. Rheumatol. 73, 225–232 (2014). https://doi.org/10.1007/s00393-013-1243-5

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Schlüsselwörter

  • Behandlung
  • Rheumatoide Arthritis
  • Senioren
  • Infektionsrisiko
  • Impfung

Keywords

  • Treatment
  • Rheumatoid arthritis
  • Elderly
  • Risk of infection
  • Vaccination