Medikamentöse Therapie der infektiösen Diarrhö

Abstract

Diarrheal diseases are among the most common diseases worldwide. In this review the current treatment recommendations for acute (Part 1) and chronic (Part 2) infectious diarrhea are summarized and typical enteropathogens are discussed. The second part of the article describes chronic diarrhea, its related pathogens and treatment. In contrast to acute diarrhea which is mainly caused by viral and typical bacterial pathogens, chronic diarrhea has mainly non-infectious origins. Protozoal pathogens, such as Giardia lamblia and Entamoeba histolytica in particular are found and more rarely bacterial pathogens, such as Tropheryma whipplei. Opportunistic pathogens cause diarrhea in immunocompromised patients, such as in HIV patients. In these patients cytomegalovirus (CMV) colitis or infections with Cryptosporidium spp., Cyclospora cayetanensis, Isospora belli or microsporidia have to be considered. Besides targeted specific antimicrobial therapy, anti-retroviral drugs improving the underlying immunosuppression and thus the reconstitution of the adaptive immune response remain a cornerstone of the treatment in HIV-positive patients.

Chronische infektiöse Diarrhö

“…Bei immunkompetenten Patienten kann Nitazoxanid erfolgreich eingesetzt werden. Eine Kombination von Paromomycin und Azithromycin erscheint versuchsweise ebenfalls möglich, ohne dass dafür eine hinreichende Evidenz gegeben wäre (zur Übersicht siehe auch [22]). Wenn möglich sollte der Grad der Immunsuppression reduziert werden.…”