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Rezidivierende Harnwegsinfektionen der Frau

Antibiotische Langzeitprophylaxe

Recurrent urinary tract infection in women

Long-term antibiotic prophylaxis

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Zusammenfassung

Harnwegsinfekte (HWI) zählen zu den häufigsten bakteriellen Infektionen bei Frauen. Überwiegend junge Frauen, aber auch postmenopausale Frauen sind von rezidivierenden HWI (rHWI), definiert als ≥3 HWI/Jahr, betroffen, wobei überwiegend keine therapierbaren prädisponierenden Faktoren zu finden sind. Therapeutisch entscheidend ist die Differenzialdiagnose zwischen persistierender Infektion und Neuinfektion (rHWI). Die Antibiotikaprophylaxe zählt zu den wichtigsten therapeutischen Behandlungsregimes von rHWI. Substanzabhängig liegt ihr Wirkprinzip in der Reduktion uropathogener Keime des Darm- oder Vaginaltrakts bzw. in der Harnwegsdesinfektion. Gemäß den Leitlinien der European Association of Urology (EAU) stehen in erster Linie Nitrofurantoin, Trimethoprim oder Cotrimoxazol, bei spezifischen Indikationen Cephalexin und Fluorochinolone zur Verfügung. Indikationsabhängig sind Langzeitantibiotikagabe über 6 Monate, postkoitale Einmalgabe oder patienteninitiierte Selbsttherapie einzusetzen. Bei korrekter Indikation lässt sich die Rezidivrate von rHWI um 95% senken.

Abstract

Urinary tract infections (UTI) are among the most frequent bacterial infections in women. Mostly young women and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI), defined as ≥3 UTI/year. Modifiable predisposing factors are rare. The differential diagnosis between relapse and reinfection is decisive for therapy. Antibiotic prophylaxis has emerged as one of the most important therapeutic principles in rUTI. Depending on the drug utilized, the various modes of action are described as reducing the number of uropathogens in the gut and vaginal flora and/or in repeatedly eliminating bacteria from the urine. According to the European Association of Urology guidelines, nitrofurantoin, trimethoprim, and cotrimoxazole are available as first-line drugs. Cephalexin and the quinolones should be restricted to specific indications. Depending on the case, long-term antibiotic prophylaxis for 6 months, postcoital single dose prophylaxis, or patient-initiated self-start therapy can all be used successfully. Given the correct indications, the recurrence rate of rUTI can be reduced by 95%.

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Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Urologische Praxis Dres. A. von Keitz, M. Schwickardi, M. Ludwig, Marburg

    M. Ludwig

  2. Klinik für Frauenheilkunde und Geburtshilfe, Helios-Klinikum Erfurt

    U. B. Hoyme

  3. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätskliniken Gießen und Marburg — Standort Gießen

    W. Weidner

  4. Urologische Praxis Dres. A. von Keitz, M. Schwickardi, M. Ludwig, Krummbogen 15, 35039, Marburg

    M. Ludwig

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Correspondence to M. Ludwig.

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Ludwig, M., Hoyme, U.B. & Weidner, W. Rezidivierende Harnwegsinfektionen der Frau. Urologe 45, 436–442 (2006). https://doi.org/10.1007/s00120-006-1023-9

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