Akute Bronchitis

Was ist neu?

Stand der Dinge Die akute Bronchitis ist eine selbstlimitierende, akute Entzündung der Atemwege und tritt meistens im Rahmen einer viral bedingten Erkältung in Erscheinung. Obwohl sie in der Regel nach zwei bis drei Wochen selbstlimitierend abklingt, sind viele Patienten ungeduldig und fordern mitunter eine Antibiotikabehandlung.

Diagnostik Anamnese und körperliche Untersuchung sind bei unkomplizierter akuter Bronchitis ausreichend. Bei älteren, multimorbiden oder immunsupprimierten Patienten oder Auffälligkeiten bei Vitalparametern ist eine weitergehende Differenzialdiagnostik notwendig. Die Bestimmung des Procalcitonins konnte in prospektiven Studien bisher keinen sicheren Nutzen zeigen.

Therapie Bei der unkomplizierten akuten Bronchitis erfolgt eine symptomatische Therapie. Um Fehlverschreibungen zu verhindern, sind die Edukation von Arzt und Patient sowie eine Verschreibung erst bei Zweitkontakt erfolgreich. Die antibiotische Therapie bleibt einem Risikokollektiv vorbehalten. Es bleibt abzuwarten, ob mittels Procalcitonin in Zukunft Patienten bestimmt werden können, bei denen auf eine antibiotische Therapie verzichtet werden kann.

Abstract

Respiratory tract infections and acute bronchitis are one of the major indications for which antibiotics are prescribed. As most of respiratory tract infections are caused by viruses and antibiotic therapy is rarely indicated. Reasons for the unnecessary prescription of antibiotics in this patient population are false expectations regarding the course and duration of common cold symptoms and especially coughing. After exclusion of severe diseases acute coughing should be treated with a symptom-oriented therapy. There is no reliable data on the use of antibiotic therapy in patient groups with an increased risk for severe complications. Studies on the use of laboratory makers to identify persons with bacterial infections who might benefit from antibiotic therapy and to reduce unnecessary prescriptions have been negative for CRP and inconclusive for procalcitonin. Peer-review and delayed prescribing could be demonstrated to reduce the rate of unneeded antibiotic prescriptions. Most of the symptomatic therapies employed for cough and the common cold are not studied in methodologically sound randomized controlled trials. The most common expectorants used in Germany are Ambroxol and N-Acetylcytein. For both substances there is little data supporting a benefit in patients with an acute bronchitis. Antitussiva reduce the symptom burden, but there is also a strong placebo-effect on the cough reflex.

Schlüsselwörter

Infektion - viral - Diagnostik - Therapie - Antibiotika

Key words

infection - viral - diagnostics - therapy - antibiotics

• Literatur

• 1 Heikkinen T, Järvinen A. The common cold. Lancet 2003; 361: 51-59
• 2 Kardos P, Berck H, Fuchs K-H. et al. Guidelines of the German Respiratory Society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie 2010; 64: 701-711
• 3 Huang DT, Yealy DM, Filbin MR. et al. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med 2018; 379: 236-249
• 4 Smith SM, Fahey T, Smucny J. et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2017; 6: CD000245
• 5 McKay R, Mah A, Law MR. et al. Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections. Antimicrob Agents Chemother 2016; 60: 4106-4118
• 6 Martinez KA, Rood M, Jhangiani N. et al. Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine. JAMA Intern Med 2018;
• 7 Petersen I, Johnson AM, Islam A. et al. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ 2007; 335: 982
• 8 Wark P. Bronchitis (acute). BMJ Clin Evid 2015; 2015: pii: 1508
• 9 Matthys H, de Mey C, Carls C. et al. Efficacy and tolerability of myrtol standardized in acute bronchitis. A multi-centre, randomised, double-blind, placebo-controlled parallel group clinical trial vs. cefuroxime and ambroxol. Arzneimittelforschung 2000; 50: 700-711
• 10 Eccles R. The powerful placebo in cough studies?. Pulmonary pharmacology & therapeutics 2002; 15: 303-308
• 11 Gillissen A, Richter A, Oster H. Clinical efficacy of short-term treatment with extra-fine HFA beclomethasone dipropionate in patients with post-infectious persistent cough. J Physiol Pharmacol 2007; 58 (05) 223-232
• 12 Benseñor IM, Cook NR, Lee IM. et al. Active and passive smoking and risk of colds in women. Ann Epidemiol 2001; 11: 225-231
• 13 Hemilä H. Vitamin C and Infections. Nutrients 2017; 9: 339
• 14 Martineau AR, Jolliffe DA, Hooper RL. et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356: i6583