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Inhalative Antibiotikatherapie bei Non-CF-Bronchiektasen

Inhaled antibiotic therapy of non-CF bronchiectasis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

In der Behandlung von Patienten mit zystischer Fibrose („cystic fibrosis“, CF) werden inhalative Antibiotika als Teil von evidenzbasierten Behandlungskonzepten zur Eradikation bei einer Erstinfektion mit Pseudomonas aeruginosa (PA) sowie zur Suppressionstherapie bei chronisch mit Pseudomonas kolonisierten Patienten seit Jahren erfolgreich eingesetzt. Von einer chronischen PA-Kolonisation sind auch viele Patienten mit Non-CF-Bronchiektasen (NCFB) betroffen. Hierbei handelt es sich jedoch um eine heterogene Patientengruppe mit unterschiedlichen Grunderkrankungen und die Evidenz zur Wirksamkeit inhalativer Antibiotika bei CF kann nicht unkritisch auf NCFB übertragen werden. Publizierte Daten belegen mittlerweile den klinischen Nutzen inhalativer Antibiotika bei ausgewählten NCFB-Patienten. Wird die Anwendung inhalativer Antibiotika im NCFB-Bereich erwogen, ist auf strenge Indikationsstellung, strukturierte Therapiepläne und die konsequente Umsetzung multimodaler Behandlungskonzepte zu achten.

Abstract

Inhaled antibiotic therapy is an evidence-based treatment approach for patients with cystic fibrosis (CF). It is especially used for early Pseudomonas eradication or for suppression in already chronically colonized CF patients. Pseudomonas colonization is also a major concern in non-CF bronchiectasis (NCFB) patients. This heterogeneous group of patients suffers from different underlying diseases, and evidence from the treatment of CF bronchiectasis cannot be adopted uncritically for NCFB. However, based on published studies, it became apparent that also patients with NCFB might benefit from the use of nebulized antibiotics. With respect to the growing but not yet solid evidence, nebulized antibiotics should only be used in selected NCFB patients with clearly defined indications and as part of an integrated multimodal therapeutic concept.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Flick erhielt Unterstützungen für Kongressbesuche und als Referent bzw. Berater Honorare von AOP Orphan Pharmaceuticals, Bayer und Forest. M. Meilinger erhielt Unterstützungen für Kongressbesuche von Forest, GSK, Novartis und MSD. M. Wagner erhielt Unterstützungen für Kongressbesuche von AOP Orphan Pharmaceuticals und Gilead. H. Olschewski erhielt als Referent bzw. Berater Honorare von Actelion, Almirall, Astra Zeneca, Bayer, Boehringer, Chiesi, GSK, Gilead, Intermune, Lilly, Novartis, Pfizer, Takeda Pharma. E. Eber erhielt als Referent bzw. Berater Honorare von AOP Orphan Pharmaceuticals, Chiesi, Gilead und Novartis. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 20, 8036, Graz, Österreich

    H. Flick, M. Meilinger & H. Olschewski

  2. Universitätsklinik für Kinder- und Jugendheilkunde, Klinische Abt. für Pädiatrische Pulmonologie und Allergologie, LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Graz, Österreich

    M. Wagner & E. Eber

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  1. H. Flick
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  2. M. Meilinger
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  4. H. Olschewski
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  5. E. Eber
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Correspondence to H. Flick.

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Flick, H., Meilinger, M., Wagner, M. et al. Inhalative Antibiotikatherapie bei Non-CF-Bronchiektasen. Pneumologe 11, 323–329 (2014). https://doi.org/10.1007/s10405-013-0765-5

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