Halsschmerzen in der Hausarztpraxis

H. Wächtler; E. Baum

doi:10.1055/s-2007-970156

ZFA - Zeitschrift für Allgemeinmedizin, Table of Contents

ZFA (Stuttgart) 2007; 83(3): 118-126
DOI: 10.1055/s-2007-970156

Leitlinie

Halsschmerzen in der Hausarztpraxis

Sore Throat in General PracticeH. Wächtler¹ , E. Baum²

¹Institut für Allgemeinmedizin, Universitatsklinikum Schleswig-Holstein, Campus Kiel
²Abteilung Allgemeinmedizin, Präventive u. Rehabilitative Medizin, Philipps-Universität Marburg

Abstract

Zusammenfassung

Ziele: Veränderte epidemiologische Bedingungen einerseits und zunehmende Antibiotikaresis-tenzen andererseits sind Anlass, die Behandlung von Patienten mit Halsschmerzen in der Hausarztpraxis zu überdenken.

Methoden: Im Rahmen eines Leitlinienprojektes der DEGAM wurde die Literatur zum Thema Halsschmerzen und Pharyngitis in Bezug auf Epidemiologie, Diagnostik, natürlichen Verlauf und Komplikationen sowie Therapieeffekte gesichtet und unter dem Aspekt der hausärztlichen Versorgungsebene bewertet.

Ergebnisse: Die Pharyngitis ist in der Regel eine kurze, selbstlimitierende Erkrankung. Eine eindeutige ätiologische Zuordnung ist meistens nicht möglich. Die Wirkung von Antibiotika auf Symptome und Krankheitsdauer ist allenfalls moderat, jedoch etwas ausgeprägter bei typischen klinischen Zeichen und Nachweis von β-hämolysierenden Streptokokken der Gruppe A (GAS, S. pyogenes). Peritonsillarabszess und andere eitrige Komplikationen sind selten. Das Akute Rheumatische Fieber (ARF) ist in westlichen Industrieländern extrem selten geworden. Dieser Rückgang ist nicht erklärbar mit einer konsequenten Antibiotikabehandlung von GAS-Pharyngitiden.

Schlussfolgerungen: Eine routinemäßige Antibiose zur Prävention von Komplikationen wie Peritonsillarabszess oder (bei GAS-Pharyngitis) Akutem Rheumatischem Fieber halten wir in unserer epidemiologischen Situation nicht für indiziert. Zur Symptomlinderung und Krankheitsverkürzung sollten Antibiotika bei schwererer Erkrankung und Zeichen einer GAS-Pharyngitis gegeben werden, wenn Arzt und Patient die erwartete Wirkung für relevant halten. Ein Algorithmus für die Entscheidungsfindung wird vorgestellt. Antibiotikum der Wahl ist Penicillin. Alle Patienten sollten zur Prognose informiert werden, und allen ist eine Behandlung mit Analgetika vorzuschlagen.

Abstract

Aims: Both increasing rates of antibiotic resistance in ambulatory care and changes in the epidemiology especially of acute rheumatic fever (ARF) demand a critical appraisal of how to treat patients with sore throat in general practice.

Methods: Within our DEGAM-Guideline-Project, the literature on sore throat and pharyngitis has been reviewed with regards to epidemiology, diagnosis, natural course and complications as well as therapeutic effects under the aspect of primary care.

Results: In most cases, sore throat is a short and self-limited disease. Usually, an accurate etiologic diagnosis is not possible. The effect of antibiotics on symptoms and signs and duration of disease is, at best, moderate. It is somehow more pronounced in patients with typical clinical symptoms and signs and presence of GAS (group A streptococci, S. pyogenes). Quinsy and other suppurative complications are rare. ARF has become extremely rare in western industrialized countries. This decline is not due to a consistent antibiotic treatment of GAS sore throats.

Conclusions: In our view, in patients with sore throat routine antibiotic treatment for the prevention of complications like quinsy or (in cases with GAS-pharyngitis) ARF should not be recommended in our epidemiological situation. In cases of more severe illness and symptoms and signs of GAS-pharyngitis, an antibiotic might be given for symptomatic relief and to shorten the duration of illness, if the doctor and the patient think it's justified by the expected effect. An algorithm for decision making is proposed. Penicillin is the first choice. All patients should be told the prognosis, and all should be advised to take analgesic drugs.

Schlüsselwörter

Halsschmerz - Pharyngitis - Streptokokkeninfektion - Komplikationen - Antibiotikaverodnung

Key words

sore throat - pharyngitis - GAS - complications - prescription of antibiotics

Full Text

References

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Korrespondenzadresse

Dr. med. H. Wächtler

Institut für Allgemeinmedizin Universitatsklinikum Schleswig-Holstein

Campus Kiel

Dorfstraße 27

23701 Eutin-Fissau

Email: hannelore.waechtler@dgn.de