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Antibiotische Dauerprophylaxe bei Harnwegsinfektionen

Wann, womit, wie lange?

Long-term antibiotic prophylaxis in urinary tract infections

When, what with and how long for?

  • Leitthema
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Zusammenfassung

Allgemein akzeptierte Indikationen für eine antibakterielle Langzeitinfektionsprophylaxe zum Schutz vor Harnwegsinfektionen (HWI) sind der höhergradige vesikoureterale Reflux, obstruktive Uropathien (z. B. obstruktiver Megaureter, Urethralklappen) und häufig rezidivierende, symptomatische HWI insbesondere des oberen Harntrakts. Es kommen v. a. Nitrofurantoin, Trimethoprim und Zephalosporine zum Einsatz. Der Nutzen einer Langzeitinfektionsprophylaxe hinsichtlich der Rezidivhäufigkeit und insbesondere der Ausbildung pyelonephritischer Parenchymschäden in definierten Patientenkollektiven ist jedoch wissenschaftlich noch nicht hinreichend belegt. Resistenzentwicklung, Nebenwirkungen und Akzeptanzprobleme erfordern die intensive Suche nach Alternativen. Neben der Verordnung antibakteriell wirksamer Medikamente sind eine gezielte Therapie eventuell begleitender Blasenfunktionsstörungen, Obstipationsneigung und anderer prädisponierender Faktoren eine wesentliche Voraussetzung für die Verringerung des Rezidivrisikos.

Abstract

Symptomatic dilating vesicoureteric reflux, severe obstructive uropathies (e.g. urethral valves, obstructive megaureter) and recurrent symptomatic urinary tract infections (UTIs), especially of the upper urinary tract, are accepted indications for long-term antibacterial prophylaxis. Nitrofurantoin, trimethoprim and cephalosporines are frequently prescribed in these conditions. However, the scientific evidence that long-term antibacterial prophylaxis in defined patient subgroups really reduces indeed the risk of recurrent UTI and, especially, the risk of renal scarring, is slight. The development of resistance to antibiotics and side effects, and poor acceptance among patients or their parents, make an intense search for alternative strategies in prevention of UTIs necessary. Prophylaxis should not be restricted to the use of antibiotics or other prophylactic agents, but must also include the efficient management of bladder and/or bowel dysfunction and treatment of any other predisposing factors.

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  1. Abteilung Kinderheilkunde I (Schwerpunkte: Allgemeine Kinderheilkunde, Stoffwechsel, Gastroenterologie, Nephrologie), Universitätsklinik für Kinder- und Jugendmedizin, Im Neuenheimer Feld 150, 69120, Heidelberg, Deutschland

    B. Tönshoff

  2. Klinik für Kinder- und Jugendmedizin, Johannes Gutenberg-Universität, Mainz, Deutschland

    R. Beetz

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  1. B. Tönshoff
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Correspondence to B. Tönshoff.

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Tönshoff, B., Beetz, R. Antibiotische Dauerprophylaxe bei Harnwegsinfektionen. Monatsschr Kinderheilkd 155, 242–251 (2007). https://doi.org/10.1007/s00112-007-1471-3

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