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DOI: 10.1055/s-2006-944591
© Georg Thieme Verlag KG Stuttgart · New York
Antibiotika im ambulanten und stationären Bereich
Publikationsverlauf
Publikationsdatum:
23. Oktober 2007 (online)
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Kernaussagen
Die Verordnung von Antibiotika im ambulanten, wie im stationären Bereich ist trotz vieler Empfehlungen zu den verschiedensten Aspekten des Einsatzes immer noch als problematisch einzustufen. Aufgrund der vielfältigen immer deutlicher werdenden Auswirkungen dieser Substanzgruppe auf den Patienten, die Mikroorganismen und die Umwelt, mehren sich die Versuche, die Verordnungsgewohnheiten deutlich zu ändern. Deshalb wäre es dringend notwendig, in den Empfehlungen/Leitlinien der Fachgesellschaften zur Antibiotikatherapie neben allgemein gehaltenen Verordnungshinweisen auch eine Verpflichtung zur Einführung geeigneter Antibiotika-Kontroll-Strukturen aufzunehmen und praktische Hinweise zur Umsetzung zu geben. Das Installieren irgendeines, der in der Fachliteratur diskutierten, Antibiotika-Strategieprogramme, welches aber typischerweise Fortbildung, Antibiotika-Verbrauchsanalysen und die Möglichkeit, auf Experten-Konsile zurückzugreifen enthalten muss, ist besser als die Alternative einer unkontrollierten Antibiotikaanwendung, wie sie heutzutage überwiegend praktiziert wird [30].
Literatur
- 1 Arnold S R, Straus S E. Interventions to improve antibiotic prescribing practices in ambulatory care. The Cochrane Database of Systematic Reviews 2005, Issue 4. The Cochrane Library. 2006; 2 1-65
- 2 Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P. Interventions to improve antibiotic prescribing practices for Hospital inpatients. The Cochrane Database of Systematic Rewiews 2005, Issue 4. The Cochrane Library. 2006; 2 1-89
- 3 Gould I M. Antibiotic policies and control of resistance. Curr Opin Infect Dis. 2002; 15 395-400
- 4 Gyssens I C. Quality measures of antimicrobial drug use. Int J Antimicrob Agents. 2001; 17 9-19
- 5 Cadwagan A M, Kumarasamy Y, Gould I M. Antimicrobial use in a medical admissions unit - liaison with microbiology. J Infect. 2001; 43 A28
- 6 Van de Velde H. Étude sur le mécanisme de la virulence du Staphylocoque pyogène. La Cellule. 1894; 10 401-460
- 7 Hidron A I, Kourbatova E V, Halvosa J S, Terrel B J, McDougal L K, Tenover F C, Blumberg H M, King M D. Risk Factors for Colonization with Methicillin-Resistant Staphylococcus aureus (MRSA) in Patients Admitted to an Urban Hospital: Emergence of Community-Associated MRSA Nasal Carriage. Clin Infect Dis. 2005; 41 159-166
-
8 File Jr T M.
Impact of Guidelines on Antimicrobial Treatment of Respiratory Tract Infections. In: Owens RC Jr, Ambrose PG, Nightingale CH Antibiotic Optimization, Concepts and Strategies In Clinical Practice. New York; Marcel Dekker 2005: 451-490 -
9 Nix D E, Erstad B L.
Optimization of Antibacterial Therapy to Minimize Costs, Medication Errors, and Adverse Outcomes. In: Owens RC Jr, Ambrose PG, Nightingale CH Antibiotic Optimization, Concepts and Strategies In Clinical Practice. New York; Marcel Dekker 2005: 89-114 - 10 Grimshaw J M, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, OŽBrien M A. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001; 39 II2-45
- 11 Gross P A, Pujat D. Implementing practice guidelines for appropriate antimicrobial usage: a systematic review. Med Care. 2001; 39 II55-69
- 12 Gonzales R, Steiner J F, Lum A, Barrett Jr P H. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999; 281 1512-1519
- 13 Goldmann D A, Weinstein R A, Wenzel R P, Tabian O C, Duma R J, Gaynes R P, Schlosser J, Martone W J. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hopsitals. A challenge to hospital leadership. JAMA. 1996; 275 234-240
- 14 Mol P G, Wierings J E, Nannanpanday P V, Gans R O, Degener J E, Laseur M, Haaijer-Ruskamp F M. Improving compliance with hospital antibiotic guidelines: a time-series intervention analysis. J Antimicrob Chemother. 2005; 55 550-557
- 15 MacDougall C, Polk R E. Antimicrobial Stewardship Programs in Health Care Systems. Clin Microbiol Rev. 2005; 18 638-656
- 16 Girotti M J, Fodoruk S, Irvine-Meek J, Rotstein O D. Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: do they work?. Can J Surg. 1990; 33 385-388
- 17 Rahal J J, Urban C, Horn D, Freeman K, Segal-Maurer S, Maurer J, Mariano N, Marks S, Burns J M, Dominick D, Lim M. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA. 1998; 280 1233-1237
- 18 McDonald L C. et al . An Epidemic, Toxin Gene-Variant Strain of Clostridium difficile. N Engl J Med. 2005; 353 2433-2441
- 19 Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003; 24 699-706
- 20 Feucht C L, Rice L B. An interventional program to improve antibiotic use. Ann Pharmacother. 2003; 37 646-651
- 21 Hamilton C D, Drew R, Janning S W, Latour J K, Hayward S. Excessive use of vancomycin; a successful intervention strategy at an academic medical center. Infect Control Hosp Epidemiol. 2000; 21 42-45
- 22 Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik S D. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med. 1998; 244 379-386
- 23 Lodise T P, McKinnon P S, Swiderski L, Rybak M J. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003; 36 1418-1423
- 24 MacArthur R D, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, Barchuk W. Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the Monarcs trial. Clin Infect Dis. 2004; 38 284-288
- 25 Kollef H M. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis. 2000; 31 (Suppl. 4) S131-S138
- 26 Micek S T, Ward S, Fraser V J, Kollef M H. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004; 125 1791-1799
- 27 Merz L R, Warren D K, Kollef M H, Fraser V J. Effects of an antibiotic cycling program on antibiotic prescribing practices in an intensive care unit. Antimicrob Agents Chemother. 2004; 48 2861-2865
-
28 David B D, Regev-Yochay G, Rubinstein E.
Abbreviated Courses of Antibacterial Therapy. In: Owens RC Jr, Ambrose PG, Nightingale CH Antibiotic Optimization, Concepts and Strategies In Clinical Practice. New York; Marcel Dekker 2005: 491-518 - 29 Trepka M J, Belongia E A, Chyou P H, Davis J P, Schwartz B. The Effect of a Community Intervention Trial on Parental Knowledge and Awareness of Antibiotic Resistance and Appropriate Antibiotic Use in Children. Pediatrics. 2001; 107 1-7
-
30 O'Donnell J, Gelone S P, Levison M E.
Antibiotic Control Systems. In: Abrutyn E, Goldmann DA, Scheckler WE Saunders Infection Control Reference Service: The Experts’ Guide to the Guidelines, 2nd Edition. Philadelphia; W. B. Saunders Company 2001: 45-52
PD Dr. med. habil. Heinz-Michael Just
Klinikum Nürnberg
Prof.-Ernst-Nathan-Straße 1 · 90419 Nürnberg
eMail: b.wagner@klinikum-nuernberg.de