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Dtsch Med Wochenschr 2012; 137(06): 267-270
DOI: 10.1055/s-0031-1298878
Aktuelle Diagnostik & Therapie | Review article
Pharmakotherapie, Infektiologie
© Georg Thieme Verlag KG Stuttgart · New York

Sind Monotherapien mit β-Laktamantibiotika noch zeitgemäß?

Is monotherapy with β-lactam antibiotics still up to date? – New aspects for treatment of severe infections
P. Heizmann
1   Innere Medizin, Klinik St.Wolfgang, Bad Griesbach
,
H. Lode
2   Institut für Klinische Pharmakologie, Charité – Universitätsmedizin, Berlin
,
W. R. Heizmann
3   amedes MVZ für Laboratoriumsmedizin, München
› Author Affiliations
Further Information

Publication History

24 August 2011

15 December 2011

Publication Date:
31 January 2012 (online)

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Zusammenfassung

Das Krankheitsbild der Sepsis weist nach wie vor eine hohe Letalität auf. Entscheidend für den Therapieerfolg sind der frühzeitige Beginn sowie die Auswahl des Antibiotikums bzw. einer Antibiotikakombination. Vielfach wird der primäre Einsatz von β-Laktamantibiotika mit bakterizider Wirkung präferiert. Tatsächlich kann aber durch diese Substanzen das Immunsystem über die Freisetzung von Zellwandbestandteilen oder Exotoxinen maximal stimuliert werden, was unter Umständen die klinische Situation der Patienten verschlechtert. Bakteriostatisch wirkende Antibiotika wirken dagegen meist über eine Inhibition der Eiweißsynthese, was zur Folge hat, dass die Bildung wichtiger Virulenzfaktoren vermindert wird und die Freisetzung von Zellwandbestandteilen sehr viel geringer ist. Die vorliegende Übersicht fasst die heutigen Erkenntnisse über den Stellenwert einiger bakteriostatisch wirkender Substanzen zusammen und es wird diskutiert, ob eine Kombination aus bakterizid und bakteriostatisch wirkenden Antibiotika bei schweren Infektionen sinnvoll sein kann.

Abstract

Mortality of sepsis is still high. Crucial for therapeutic response are the early start of treatment as well as the choice of antibiotics or antibiotic combinations. β-lactam antibiotics with bactericidal mode of action are often recommended in guidelines. But this antiobiotic class can trigger the immunosystem to a maximum by releasing cell wall components or exotoxins. This may lead to a worsening of the patient’s clinical situation. In contrast, antibiotics with bacteriostatic action often inhibit bacterial protein synthesis with decrease of production of virulence factors and minimize release of cell wall components. The purpose of this review is to summarise the significance of some bacteriostatic antibiotics and to discuss whether a combination of bactericidal and bacteriostatic agents may improve the course of the illness.

Schlüsselwörter

Sepsis - Bakteriostase - Bakterizidie - Kombinationstherapie - Virulenzfaktoren

Keywords

sepsis - bacteriostatic - bactericidal - combination therapy - virulence
 

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