Skip to main content
SpringerLink
Log in

Die unkomplizierte Harnwegsinfektion

Im Blickpunkt: Pivmecillinam und Nitroxolin in der antibiotischen Therapie

Uncomplicated urinary tract infections

In focus: Pivmecillinam and nitroxoline in the antibiotic treatment

  • Frauengesundheit in der Praxis
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die neue S3-Leitlinie zu Harnwegsinfektionen empfiehlt nicht mehr die Chinolone als Mittel der ersten Wahl. Neben Fosfomycin, Nitrofurantoin und Pivmecillinam, das jetzt in Deutschland im Handel zur Verfügung steht, ist nun auch Nitroxolin als ein primäres Medikament bei der kalkulierten Therapie unkomplizierter Harnwegsinfektionen platziert. Außerdem ist Nitroxolin auch zur Prophylaxe rezidivierender Harnwegsinfektionen zugelassen. Der Stellenwert der diversen Antibiotika im Vergleich zu Pivmecillinam und Nitroxolin wird erörtert. Außerdem werden in kompakter Form die Möglichkeiten der Prävention dargestellt.

Abstract

The new S3 guidelines on urinary tract infections no longer recommend quinolones as first-line treatment. In addition to fosfomycin, nitrofurantoin and pivmecillinam, which is now available on the market in Germany, nitroxoline is now also placed as a primary medication for the calculated treatment of uncomplicated urinary tract infections. Nitroxoline is also approved for prophylaxis of recurrent urinary tract infections. The importance of the diverse antibiotics in comparison to pivmecillinam and nitroxoline is explained. The possibilities for prevention are also briefly presented.

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

Literatur

  1. Ingersoll MA, Albert ML (2013) From infection to immunotherapy: host immune responses to bacteria at the bladder mucosa. Mucosal Immunol 6:1041–1053

    Article  PubMed  CAS  Google Scholar 

  2. Hof H (2015) Harnwegsinfektionen – Teil 1: Pathogenese. Prakt Gynecol 20:358–365

    Google Scholar 

  3. Dobrindt U (2010) Virulenzfaktoren uropathogener Erreger. Urologe 49:598–605

    Article  PubMed  CAS  Google Scholar 

  4. Alteri CJ, Mobley HL (2015) Metabolism and fitness of urinary tract pathogens. Microbiol Spectr. https://doi.org/10.1128/microbiolspec

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hooton TM, Roberts PL, Cox ME, Stapleton AE (2013) Voided midstream urine culture and acute cystitis in premonopausal women. N Engl J Med 369:18883–18891

    Article  CAS  Google Scholar 

  6. Bodman KF (Hrsg) (2012) Therapiemanagement nosokomialer Infektionen. UNI-MED, Bremen, S 11

    Google Scholar 

  7. Wagenlehner F, Schiemann G (2017) Interdisziplinäre S3 Leitlinie. Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Aktualisierung 2017 AWMF-Register-Nr. 043/044

    Google Scholar 

  8. Parsons RL, Hossack GA, Paddock GM (1977) Pharmacokinetics of pivmecillinam. Br J Clin Pharmacol 4:267–273

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Graninger W (2003) Pivmecillinam—therapy of choice for lower urinary tract infection. Int J Antimicrob Agents 22(Suppl 2):73–78

    Article  PubMed  CAS  Google Scholar 

  10. Kresken M, Körber-Irrgang B, Naber KG (2017) In-vitro Wirksamkeit von Mecillinam gegen Urinisolate von Escherichia coli von Patienten im niedergelassenen Versorgungsbereich in Deutschland. Aktuelle Urol 48:243–247

    Article  PubMed  Google Scholar 

  11. O’Kelly F, Kavanagh S, Manecksha R, Thornhill J, Fennell JP (2016) Characteristics of gram-negative urinary tract infections caused by extended spectrum beta lactamases: pivmecillinam as a treatment option within South Dublin, Ireland. BMC Infect Dis 16:620

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Haasum Y, Fastbom J, Johnell K (2013) Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study. Eur J Clin Pharmacol 69:665–671

    Article  PubMed  CAS  Google Scholar 

  13. Sester U (2012) Harnwegsinfektionen. Nephrologe 7:289–297

    Article  Google Scholar 

  14. Pelletier C, Prognon P, Bourlioux P (1995) Roles of divalent cations and pH in mechanism of action of nitroxoline against Escherichia coli strains. Antimicrob Agents Chemother 39:707–713

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Fraser RS, Creanor J (1974) Rapid and selective inhibition of RNA synthesis in yeast by 8‑hydroxyquinoline. Eur J Biochem 46:67–73

    Article  PubMed  CAS  Google Scholar 

  16. Sobke A, Klinger M, Hermann B, Sachse S, Nietzsche S, Makarewicz O, Keller PM, Pfister W, Straube E (2012) The urinary antibiotic 5‑nitro-8-hydroxyquinoline (Nitroxoline) reduces the formation and induces the dispersal of Pseudomonas aeruginosa biofilms by chelation of iron and zinc. Antimicrob Agents Chemother 56:6021–6025

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Hof H, Bertsch D, Passek D, Schwarz R (2017) Nitroxolin – eine Option zur antibiotischen Therapie von Harnwegsinfektionen. Urologe 56:167–171

    Article  PubMed  CAS  Google Scholar 

  18. Kresken M, Körber-Irrgang B (2014) In vitro activity of nitroxoline against Escherichia coli urine isolates from outpatient departments in Germany. Antimicrob Agents Chemother 58:7019–7020

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Hof H (2015b) Harnwegsinfektionen – Teil 2: Therapie. GYN 20:432–441

    Google Scholar 

  20. Sastry S, Clarke LG, Alrowais H, Querry AM, Shutt KA, Doi Y (2015) Clinical appraisal of fosfomycin in the era of antimicrobial resistance. Antimicrob Agents Chemother 59:7355–7361

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Nathanson S, Desch’e’nes G (2002) Antibioprophylaxie urinaire. Arch Pediatr 9:511–518

    Article  PubMed  CAS  Google Scholar 

  22. Silverman JA, Schreiber HL, Hooton TM, Hultgren SF (2013) From phyisology to pharmacy: developments in the pathogenesis and treatment of recurrent urinary tract infections. Curr Urol Rep 14:448–456

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kranz J, Helbig S, Mandraka F, Schmidt S, Naber KG (2017) The revival of old antibiotics for treatment of uncomplicated urinary tract infections in the era of antibiotic stewardship. Curr Opin Urol 27:127–132

    Article  PubMed  Google Scholar 

  24. Anonymus (2016) Harnwegsinfektionen – resistente Erreger bedeutsam? Zschr Infektionstherapie 37(3):21–22

    Google Scholar 

  25. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I (2016) Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci 14:Doc1

    PubMed  PubMed Central  Google Scholar 

  26. Hof H (2014) Intracellular habitat of pathogenic microorganisms: implications for antimicrobial chemotherapy. GMS Infect Dis 2:Doc1. https://doi.org/10.3205/id000009

    Article  Google Scholar 

  27. Bergamin PA, Kiosoglous AJ (2017) Non-surgical management of recurrent urinary tract infection in women. Transl Androl Urol 6(Suppl. 2):S142–S152

    Article  PubMed  PubMed Central  Google Scholar 

  28. Palleschi G, Carbone A, Zanello PP, Mele R, Leto A, Fuschi A, Al Salhi Y, Velotti G, Al Rawashdah S, Coppola G, Maurizi A, Maruccia S, Pastore AL (2017) Prospective study to compare antibiosis versus the association of N‑acetylcysteine, D‑mannose and Morinda citrifolia fruit extract in preventing urinary tract infections in patients submitted to urodynamic investigation. Arch Ital Urol Androl 89:45–50

    Article  PubMed  CAS  Google Scholar 

  29. Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G (2013) Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol 190:1981–1989

    Article  PubMed  CAS  Google Scholar 

  30. Hannan TJ, Hooton TM, Hultgren SJ (2013) Estrogen and recurrent UTI: what are the facts? Sci Transl Med 5:190fs23

    Article  PubMed  CAS  Google Scholar 

  31. Piechota H (2017) Rezidivierende und kathetrassoziierte Harnwegsinfektionen. Prophylaxe und Prävention. Urologe 56:734–745

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MVZ Labor Limbach und Kollegen, Im Breitspiel 16, 69126, Heidelberg, Deutschland

    Herbert Hof

Authors
  1. Herbert Hof
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herbert Hof.

Ethics declarations

Interessenkonflikt

H. Hof gibt an, dass kein Interessenkonflikt besteht.

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

Additional information

Redaktion

K. Friese, Oberaudorf

G. Gille, Lüneburg

K. Schaudig, Hamburg

A. Schwenkhagen, Hamburg

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hof, H. Die unkomplizierte Harnwegsinfektion. Gynäkologe 51, 581–589 (2018). https://doi.org/10.1007/s00129-018-4263-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-018-4263-z

Schlüsselwörter

Keywords

Search

Navigation