Skip to main content
SpringerLink
Log in

Gastrointestinale Nebenwirkungen von Antibiotika

Gastrointestinal side effects of antibiotics

  • Schwerpunkt: Medikamentöse Nebenwirkungen im Gastrointestinaltrakt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Gastrointestinale Nebenwirkungen sind eine häufige Folge einer antibiotischen Therapie, die durch direkte Effekte auf den Gastrointestinaltrakt oder durch Störungen der intestinalen Flora verursacht werden können. Dies begünstigt u. a. die Infektion, Überwucherung und Toxinbildung durch Clostridium difficile, des bedeutsamsten Erregers einer antibiotikaassoziierten Diarrhö. Symptomatik, Diagnose, Therapie und Prävention der C.-difficile-assoziierten Diarrhö und der pseudomembranösen Kolitis werden beschrieben und diskutiert. C. difficile stellt eine bleibende Herausforderung nicht zuletzt aufgrund der Entwicklung neuer Stämme mit erhöhter Toxinbildung dar.

Abstract

Gastrointestinal side effects are a frequent result of therapy with antibiotics as these have direct effects on the gastrointestinal tract or affect the gut microflora. This may cause infection, overgrowth and toxin secretion by Clostridium difficile, an important pathogen responsible for antibiotic-associated (pseudomembranous) colitis. The symptoms, diagnosis, treatment and prevention of C. difficile colitis are presented and discussed in detail. C. difficile represents a continuous challenge, for example due to new strains with enhanced toxin production..

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Acar JF (2001) A comparison of side effects of levofloxacin to other agents concerning the ecological and microbiological effects on normal human flora. Chemotherapy 47 [Suppl 3]: 15–23

    Article  Google Scholar 

  2. Anzueto A, Niederman MS, Pearle J et al. (2006) Community-acquired pneumonia recovery in the elderly (CAPRIE): efficacy and safety of Moxifloxacin therapy versus that of Levofloxacin therapy. Clin Infect Dis 42: 73–81

    Article  PubMed  Google Scholar 

  3. Aslam S, Hamill RJ, Musher DM (2005) Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis 5: 549–557

    Article  PubMed  Google Scholar 

  4. Barbut F, Petit JC (2001) Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 7: 405–410

    Article  PubMed  Google Scholar 

  5. Bartlett JG (1994) Clostridium difficile: history of its role as an enteric pathogen and the current state of knowledge about the organism. Clin Infect Dis 18 [Suppl 4]: 265–272

    PubMed  Google Scholar 

  6. Bartlett JG (2002) Antibiotic-associated diarrhea. N Engl J Med 346: 334–339

    Article  PubMed  Google Scholar 

  7. Bartlett JG, Perl TM (2005) The new Clostridium difficile – what does it mean? N Engl J Med 353: 2503–2505

    Article  PubMed  Google Scholar 

  8. Beaugerie L, Petit JC (2004) Antibiotic-associated diarrhoea. Best Prac Res Clin Gastroenterol 18: 337–352

    Article  Google Scholar 

  9. Chassany O, Michaux A, Bergmann JF (2000) Drug-induced diarrhoea. Drug Saf 22 (1): 53–72

    Article  PubMed  Google Scholar 

  10. Curry JI, Lander TD, Stringer MD (2001) Review article: erythromycin as a prokinetic agent in infants and children. Aliment Pharmacol Ther 15: 595–603

    Article  PubMed  Google Scholar 

  11. Gaynes R, Rimland D, Killum E et al. (2004) Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 38: 640–645

    Article  PubMed  Google Scholar 

  12. Högenauer C, Hammer HF, Krejs GJ et al. (1998) Mechanism and management of antibiotic-associated diarrhea. Clin Infect Dis 27: 702–710

    PubMed  Google Scholar 

  13. Hurley BW, Nguyen CC (2002) The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea. Arch Intern Med 162: 2177–2184

    Article  PubMed  Google Scholar 

  14. Jaspersen D (2000) Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management. Drug Saf 22: 237–249

    Article  PubMed  Google Scholar 

  15. Just I, Gerhard R (2004) Large clostridial cytotoxins. Rev Physiol Biochem Pharmacol 152: 23–47

    Article  PubMed  Google Scholar 

  16. Lartey PA, Nellans HN, Tanaka SK (1994) New developments in macrolides: structures and antibacterial and prokinetic activities. Adv Pharmacol 28: 307–343

    PubMed  Google Scholar 

  17. Lenzen-Großimlinghaus R, Strohmeyer G (2003) Antibiotika-assoziierte Diarrhoe. Dtsch Med Wochenschr 128: 437–439

    Article  PubMed  Google Scholar 

  18. Leung WK, Chan FKL, Fung SSL et al. (2005) Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. World J Gastroenterol 11: 4865–4868

    PubMed  Google Scholar 

  19. Loo VG, Poirier L, Miller MA et al. (2005) A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 353: 2442–2449

    Article  PubMed  Google Scholar 

  20. Makins R, Ballinger A (2003) Gastrointestinal side effects of drugs. Expert Opin Drug Saf 2: 421–429

    Article  PubMed  Google Scholar 

  21. Marteau P, Seksik P, Jian R (2002) Probiotics and intestinal health effects: a clinical perspective. Br J Nutr 88 [Suppl 1]: 51–57

    Article  PubMed  Google Scholar 

  22. McCusker ME, Harris AD, Perencevich E et al. (2003) Fluoroquinolone use and Clostridium difficile-associated diarrhea. Emerg Infect Dis 9: 730–733

    PubMed  Google Scholar 

  23. McDonald LC, Killgore GE, Thompson A et al. (2005) An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 353: 2433–2441

    Article  PubMed  Google Scholar 

  24. McFarland LV (1998) Epidemiology, risk factors and treatments for antibiotic-associated diarrhea. Dig Dis 16: 292–307

    Article  PubMed  Google Scholar 

  25. Musher DM, Aslam S, Logan N et al. (2005) Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 40: 1586–1590

    Article  PubMed  Google Scholar 

  26. Owens, RC (2006) Clostridium difficile-associated disease: an emerging threat to patient safety. Pharmacother 26: 299–311

    Article  Google Scholar 

  27. Owens RC, Ambrose PG (2005) Antimicrobial safety: focus on fluoroquinolones. Clin Infect Dis 41 [Suppl 2]: 144–157

    Article  Google Scholar 

  28. Pepin J, Alary ME, Valiquette L et al. (2005) Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 40: 1591–1597

    Article  PubMed  Google Scholar 

  29. Pepin J, Saheb N, Coulombe MA et al. (2005) Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 41: 1254–1260

    Article  PubMed  Google Scholar 

  30. Smith DS, Ferris CD (2003) Current concepts in diabetic gastroparesis. Drugs 63: 1339–1358

    Article  PubMed  Google Scholar 

  31. Surawicz CM (2003) Probiotics, antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in humans. Best Prac Res Clin Gastroenterol 17: 775–783

    Article  Google Scholar 

  32. Surawicz CM (2005) Antibiotic-associated diarrhea and pseudomembranous colitis: are they less common with poorly absorbed antimicrobials? Chemotherapy 51 [Suppl 1]: 81–89

    Article  PubMed  Google Scholar 

  33. Surawicz CM, McFarland LV (1999) Pseudomembranous colitis: causes and cures. Digestion 60: 91–100

    Article  PubMed  Google Scholar 

  34. Valean S, Petrescu M, Catinean A et al. (2005) Pill esophagitis. Rom J Gastroenterol 14: 159–163

    PubMed  Google Scholar 

  35. Voth DE, Ballard JD (2005) Clostridium difficile toxins: mechanism of action and role in disease. Clin Microbiol Rev 18: 247–263

    Article  PubMed  Google Scholar 

  36. Warny M, Pepin J, Fang A et al. (2005) Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 366(9491): 1079–1084

    Article  PubMed  Google Scholar 

  37. Wiström J, Norrby SR, Myhre EB et al. (2001) Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 46: 43–50

    Article  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Garystraße 5, 14195, Berlin

    R. Fuhr &  R. Stahlmann

Authors
  1. R. Fuhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Stahlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Stahlmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuhr, R., Stahlmann, R. Gastrointestinale Nebenwirkungen von Antibiotika. Gastroenterologe 1, 173–179 (2006). https://doi.org/10.1007/s11377-006-0030-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-006-0030-0

Schlüsselwörter

Keywords

Search

Navigation