Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016

Ewig, Santiago; Höffken, G.; Kern, Winfried V.; Rohde, Gernot; Flick, Holger; Krause, Robert; Ott, Sebastian Robert; Bauer, Torsten T.; Dalhoff, K; Gatermann, Sören; Kolditz, Martin; Krüger, Stefan; Lorenz, Joachim; Pletz, Mathias W.; Roux, A de; Schaaf, Beate; Schaberg, T.; Schütte, Hartwig; Welte, Tobias

doi:10.1055/s-0042-101873

Cited by 165 publications

(115 citation statements)

References 94 publications

(136 reference statements)

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“…Along these recommendations, a combination of a broad-spectrum beta-lactam antibiotic (e.g. cefotaxim, ceftriaxone, piperacillin/tazobactam, ertapenem, or meropenem) in combination with a macrolide or fluoroquinolone is usually administered empirically to patients with severe CAP and septic disease progression or mechanically ventilated patients [7, 9, 10]. Fluoroquinolone monotherapy (levofloxacin or moxifloxacin) is reserved for patients without severe disease progression [7, 9, 11].…”

Section: Introductionmentioning

confidence: 99%

“…cefotaxim, ceftriaxone, piperacillin/tazobactam, ertapenem, or meropenem) in combination with a macrolide or fluoroquinolone is usually administered empirically to patients with severe CAP and septic disease progression or mechanically ventilated patients [7, 9, 10]. Fluoroquinolone monotherapy (levofloxacin or moxifloxacin) is reserved for patients without severe disease progression [7, 9, 11]. However, the recommendations to limit moxifloxacin monotherapy to patients with lesser CAP severity is supported only by evidence grade II A and is due to the lack of efficacy data on fluoroquinolones as monotherapy for the treatment of severe CAP [7, 9, 11].…”

Section: Introductionmentioning

confidence: 99%

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Moxifloxacin monotherapy versus combination therapy in patients with severe community-acquired pneumonia evoked ARDS

et al. 2017

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BackgroundWe tested the hypothesis that moxifloxacin monotherapy is equally effective and safe as a betalactam antibiotic based combination therapy in patients with acute respiratory distress syndrome (ARDS) evoked by severe community acquired pneumonia (CAP).MethodsIn a retrospective chart review study of 229 patients with adult respiratory distress syndrome (ARDS) admitted to our intensive care unit between 2001 and 2011, 169 well-characterized patients were identified to suffer from severe CAP. Patients were treated with moxifloxacin alone, moxifloxacin in combination with ß-lactam antibiotics, or with another antibiotic regimen based on ß-lactam antibiotics, at the discretion of the admitting attending physician. The primary endpoint was 30-day survival. To assess potential drug-induced liver injury, we also analyzed biomarkers of liver cell integrity.Results30-day survival (69% overall) did not differ (p = 0.89) between moxifloxacin monotherapy (n = 42), moxifloxacin combination therapy (n = 44), and other antibiotic treatments (n = 83). We found significantly greater maximum activity of aspartate transaminase (p = 0.048), alanine aminotransferase (p = 0.003), and direct bilirubin concentration (p = 0.01) in the moxifloxacin treated groups over the first 10–20 days. However, these in-between group differences faded over time, and no differences remained during the last 10 days of observation.ConclusionsIn CAP evoked ARDS, moxifloxacin monotherapy and moxifloxacin combination therapy was not different to a betalactam based antibiotic regimen with respect to 30-day mortality, and temporarily increased markers of liver cell integrity had no apparent clinical impact. Thus, in contrast to the current S3 guidelines, moxifloxacin may also be safe and effective even in patients with severe CAP evoked ARDS while providing coverage of an extended spectrum of severe CAP evoking bacteria. However, further prospective studies are needed for definite recommendations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Moxifloxacin monotherapy versus combination therapy in patients with severe community-acquired pneumonia evoked ARDS

et al. 2017

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“…In der Regel lässt sich eine bakterielle Infektion einem infizierten Organ oder einem Infektionsherd zuordnen Infektionen bei Immunsupprimierten stellen eine besondere diagnostische Herausforderung dar CME pie von Infektionen im Erwachsenenalter [3,4] oder in den Leitlinien der wissenschaftlichen Fachgesellschaften, u. a. zur Sepsis [5,6], zur ambulant erworbenen Pneumonie [7], zur nosokomialen Pneumonie [8], zu den Harnwegsinfektionen [9], zur Endokarditis [10], zu infektiösen Darmerkrankungen [11] oder zur Therapie der Helicobacter-pylori-Infektion [12].…”

Section: Indikationen Für Den Einsatz Von Antibiotikaunclassified

Rationaler Einsatz von Antibiotika

Walger

2016

Internist

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International and national campaigns draw attention worldwide to the rational use of the available antibiotics. This has been stimulated by the high prevalence rates of drug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), a threatening spread of development of resistance in Gram-negative rod-shaped bacteria and the selection of Clostridium difficile with a simultaneous clear reduction in the development of new antibiotics. The implementation of antibiotic stewardship programs aims to maintain their effectiveness by a rational use of the available antibiotics. The essential target of therapy with antibiotics is successful treatment of individual patients with bacterial infections. The optimal clinical treatment results can only be achieved when the toxicity, selection of pathogens and development of resistance are minimized. This article presents the principles of a rational antibiotic therapy.

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“…Eine Pneumonie kann primär durch Influenzaviren ausgelöst werden, zählt aber auch zu den wichtigen Komplikationen einer Influenza [6,11]. In Deutschland erkranken jährlich 400.000 bis 600.000 Menschen an ambulant erworbener Pneumonie, von denen zwischen 30 und 50 % hospitalisiert werden [12].…”

Section: Influenza Und Ambulant Erworbene Pneumonie In Hausärztlich Tunclassified

“…Dies gilt auch für die Diagnosen mit dem Zusatz "G" (gesicherte Diagnose). Obwohl in der aktuellen S3-Leitlinie eine radiologische Untersuchung empfohlen wird, wird dort auch auf die begrenzte Sensitivität, Spezifität und Zuverlässig-keit des Infiltratnachweises in der Rönt-genaufnahme hingewiesen [12]. In der Studie von Hagaman et al [44] wurden bei 21 % der Patienten mit einer ambulant erworbenen Pneumonie keine Infiltrate in der initialen Röntgenaufnah-me nachgewiesen; erst im Verlauf von 48 h haben sich bei mehr als der Hälfte dieser Patienten Infiltrate gebildet [44].…”

Section: Saisonalität Der Erfassten Arediagnosenunclassified

Influenza und ambulant erworbene Pneumonie in hausärztlich tätigen Arztpraxen in Deutschland

Zanuzdana

Köpke

Haas

2016

Bundesgesundheitsbl

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Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016

Cited by 165 publications

References 94 publications

Moxifloxacin monotherapy versus combination therapy in patients with severe community-acquired pneumonia evoked ARDS

Moxifloxacin monotherapy versus combination therapy in patients with severe community-acquired pneumonia evoked ARDS

Rationaler Einsatz von Antibiotika

Influenza und ambulant erworbene Pneumonie in hausärztlich tätigen Arztpraxen in Deutschland

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