Die Antibiotika-assoziierte Diarrhö

Zusammenfassung

Die Inzidenz der Antibiotika-assoziierten Diarrhö (AAD) schwankt in Abhängigkeit des verwendeten Antibiotikums zwischen 15 - 25 %. Die meisten Fälle einer AAD werden direkt oder indirekt durch Verschiebungen in der intestinalen Mikroflora verursacht, die über eine funktionelle Veränderung des intestinalen Kohlenhydrat- und Gallensäuremetabolismus in einer Diarrhö resultiert. Darüber hinaus begünstigt die Veränderung der mikrobiellen Flora die Proliferation pathogener Keime. Clostridium difficile zeichnet für 10 - 15 % aller Fälle einer AAD und der überwiegenden Anzahl der Antibiotika-assoziierten pseudomembranösen Kolitis verantwortlich. Neuere Daten belegen zudem die Bedeutung von Klebsiella oxytoca in der Entstehung einer Antibiotika-assoziierten hämorrhagischen Kolitis. Die Diagnose einer Clostridium-difficille-assoziierten Diarrhö stützt sich auf den Keim- und Toxinnachweis im Fäzes. Als Therapie der Wahl gilt die Behandlung mit Metronidazol, während die Gabe von Vancomycin oral Patienten vorbehalten sein sollte, die entweder auf Metronidazol nicht angesprochen haben oder bei denen eine Kontraindikation oder eine Intoleranz gegenüber diesem Antbiotikum vorliegt. Ein restriktiver Einsatz von Antibiotika (insbesondere Clindamycin und Cephalosporine), die Einhaltung einfacher Hygienemaßnahmen sowie die Gabe von Probiotika, wie Saccharomyces boulardii, haben sich in der Prophylaxe einer AAD als effektiv erwiesen.

Abstract

The incidence of antibiotic-associated diarrhea (AAD) differs with the antibiotic and varies from 15 - 25 %. Most cases of AAD are directly or indirectly caused by alterations of gut microflora by the antibiotics resulting in clinically mild AAD cases due to functional disturbances of intestinal carbohydrate or bile acid metabolism. Alternatively, changes in the gut flora allow pathogens to proliferate. Clostridium difficile is responsible for 10 - 15 % of all cases of AAD and almost of all cases of antibiotic-associated pseudomembraneous colitis. There is also a growing body of evidence which supports the responsibility of Klebsiella oxytoca for the development of antibiotic-associated hemorrhagic colitis. Diagnosing Clostridium difficile-associated diarrhea should be based both on fecal-cytotoxin detection and culture. With respect to specific therapy, metronidazol has become the first choice whereas treatment with oral vancomycin should be reserved for patients who have contraindications or intolerance to or who have failed to respond to metronidazole. Probiotics such as Sacharomyces boulardii can reduce the risk of development. Restrictive antibiotic policies (e. g. restricting clindamycin and cephalosporins) and the implementation of a comprehensive hospital infection control have also been shown to be effective in reducing the incidence of AAD.

Schlüsselwörter

Antibiotikum - Kolitis - Clostridium difficile

Key words

Antibiotic - Colitis - Clostridium difficile

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