Management der Sepsis: Erstantibiose bereits im Rettungs- und Notarztdienst

Pro und Kontra

Management of sepsis: initial antibiotic treatment already by the emergency medical personnel

Pro and contra

Zusammenfassung

Die Sepsis ist eine häufige und gefährliche Erkrankung, an der die Patienten oft versterben. Der Beitrag stellt die kontroverse Meinung (Pro und Kontra) zweier Autorengruppen hinsichtlich einer frühzeitigen Erstantibiose in der Präklinik vor. Die „Pro-Gruppe“ vertritt die Ansicht, dass die Patienten bereits von einer frühzeitigen Diagnose und anschließender Erstantibiose im Rettungs- und Notarztdienst profitieren. Da keine Hinweise für schädliche Folgen einer solchen Therapie existieren, ist es aus Sicht der Autoren nur schwer nachvollziehbar, weshalb eine offensichtlich lebensrettende Gabe eines Antibiotikums nicht bereits präklinisch erfolgen sollte. Die „Kontra-Gruppe“ sieht den Nutzen einer präklinischen Antibiotikatherapie für den ohnehin im Rettungsdienst seltenen und schwer zu diagnostizierenden septischen Schock nicht klar belegt. Außerdem werden neben logistischen Schwierigkeiten negative Auswirkungen hinsichtlich Diagnostik und Resistenzentwicklung befürchtet, sodass eine präklinische Antibiotikatherapie bei den hierzulande kurzen Transportzeiten überflüssig scheint.

Abstract

Sepsis is a common and dangerous disease that is often lethal. In this paper, the controversial opinion (pros and cons) of two groups of authors regarding early initial antibiotic treatment in the preclinical setting is presented. The “pro group” is of the opinion that patients already benefit from early diagnosis and subsequent initial antibiotic treatment by the emergency medical personnel. Since there is no evidence for harmful consequences of such a therapy, the authors find it difficult to understand why an obviously life-saving administration of an antibiotic should not already be carried out by emergency medical personnel. The authors arguing against the prehospital application of antibiotics („contra-position“) stress a lack of evidence supporting antibiotic use in the EMS (emergency medical services) setting. Septic shock is difficult to diagnose for and rarely treated by EMS personnel. Besides presenting logistical challenges, the authors fear a negative impact on microbiological diagnostics and antibiotic resistance. Given the short prehospital times in Germany, prehospital antibiotic therapy seems superfluous.

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Correspondence to Dr. S. Casu MHBA or Dr. F. Herbstreit.

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Interessenkonflikt

S. Casu, D. Häske, F. Herbstreit und P.-M. Rath geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

S. Casu und D. Häske haben den Pro-Teil verfasst, F. Herbstreit und P.-M. Rath schrieben den Kontra-Teil.

Redaktion

M. Bernhard, Düsseldorf

H. Dormann, Fürth

C. Waydhas, Bochum

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Casu, S., Häske, D., Herbstreit, F. et al. Management der Sepsis: Erstantibiose bereits im Rettungs- und Notarztdienst. Notfall Rettungsmed 22, 704–708 (2019). https://doi.org/10.1007/s10049-019-0566-4

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Schlüsselwörter

  • Antibiotikatherapie
  • Notfallmedizin
  • Rettungssanitäter
  • Präklinische Phase
  • Resistenz

Keywords

  • Antibiotic treatment
  • Emergency
  • Preclinical setting
  • Paramedic
  • Resistance