Unkomplizierte Harnwegsinfektion – Leitlinienkonforme Behandlung

 

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Zusammenfassung

Harnweginfektionen (HWI) sind häufige Infektionen sowohl im ambulanten als auch stationären Bereich. Im allgemeinen können HWI therapieorientiert in unkomplizierte und komplizierte / nosokomiale HWI unterteilt werden. Zu den unkomplizierten, einfachen HWI zählen die unkomplizierte Zystitis und die unkomplizierte Pyelonephritis. Beide Entitäten werden hauptsächlich durch E. coli verursacht. Allerdings finden sich auch bei den unkomplizierten HWI heutzutage zunehmende Resistenzraten, z. B. gegenüber Aminopenicillinen, Cotrimoxazol und teilweise auch Fluorchinolonen. Diese Entwicklung hat eine Neubewertung der Therapieempfehlungen bei unkomplizierten HWI notwendig gemacht. Bei der unkomplizerten Zystitis wird für die empirische Therapie an erster Stelleß Fosfomycin-Trometamol, Nitrofurantoin oder Pivmecillinam empfohlen. Für die orale Erstlinientherapie der akuten unkomplizierten Pyelonephritis werden Fluorchinolone in hoher Dosierung empfohlen. Die häufigen asymptomatischen Bakteriurien (ASB) müssen mit wenigen Ausnahmen nicht therapiert werden. Aufgrund der zunehmenden Antibiotikaresistenz und des Auftretens multiresistenter Erreger gestaltet sich eine empirische Antibiotikatherapie zunehmend schwieriger. Aus diesen Gründen sollte, wenn immer möglich, die Resistenztestung abgewartet werden. 

Abstract

Urinary tract infections (UTI) are frequent infections in the outpatient and hospital setting. With respect to treatment options, UTI can generally be stratified into uncomplicated and complicated / nosocomial infections. Uncomplicated UTI are represented by the acute uncomplicated cystitis and the uncomplicated pyelonephritis. They are mainly caused by E. coli. There are, however, also increasing resistance rates found in uncomplicated UTI, e. g., against aminopenicillins, cotrimoxazole and increasingly also fluoroquinolones. This development has called for a new evaluation of the treatment recommendations in uncomplicated UTI. As an empirical therapy for uncomplicated cystitis fosfomycin trometamol, nitrofurantoin or pivmecillinam are recommended as first-line agents. As the oral first line therapy for uncomplicated pyelonephritis fluroquinolones in high dosages are recommended. The frequent asymptomatic bacteriuria does not need to be treated, with only a few exceptions. Due to the increasing antibiotic resistance and the emergence of multiresistant uropathogens, empirical antibiotic treatment becomes more difficult. Therefore the results of susceptibility testing should be awaited whenever possible. 

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Prof. Dr. med. F. M. E. Wagenlehner

Klinik und Poliklinik für Urologie · Kinderurologie und Andrologie · Universitätsklinikum Gießen und Marburg GmbH · Standort Gießen · Justus-Liebig-Universität Gießen

Rudolf-Buchheim-Str. 7

35385 Gießen

Phone: 06 41 / 9 94 45 16

Fax: 06 41 / 9 94 45 09

Email: Wagenlehner@AOL.com

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