DGI:Durchfallerkrankungen/Erreger: Difference between revisions

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== Erreger ==
====<span class="mw-headline ve-pasteProtect">'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Akute Diarrhoen ohne Erregernachweis</span>'''</span>====
====<span class="mw-headline ve-pasteProtect">'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Akute Diarrhoen ohne Erregernachweis</span>'''</span>====
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ambulant  erworben (≤72h stationär)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ambulant  erworben (≤72h stationär)</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  Immunsuppression</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  Immunsuppression</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  Zeichen der schweren Dehydratation/</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Sepsis <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Sepsis</span>]</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  Zeichen der schweren Dehydratation/</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Sepsis <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Sepsis</span>]</span>


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|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Spezifische  Diagnostik nicht regelhaft notwendig*</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Typische  Erreger: Diversive Viren, Enteropathogene ''E. coli'', ''C.  difficile'', Salmonellen, Shigellen, Campylobacter und Yersinien</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Spezifische  Diagnostik nicht regelhaft notwendig*</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Typische  Erreger: Diversive Viren, Enteropathogene ''E. coli'', ''C.  difficile'', Salmonellen, Shigellen, Campylobacter und Yersinien</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ambulante,  supportive Therapie mit oraler Flüssigkeits- und Elekrolytzufuhr</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ambulante,  supportive Therapie mit oraler Flüssigkeits- und Elekrolytzufuhr</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  empirische antimikrobielle Therapie</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Keine  empirische antimikrobielle Therapie</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Häufig selbstlimitierend</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Häufig selbstlimitierend</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">*In folgenden Untergruppen ist eine Diagnostik notwendig:</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">*In folgenden Untergruppen ist eine Diagnostik notwendig:</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Blutige  Diarrhö</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Blutige  Diarrhö</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Patienten,  die in Gemeinschaftseinrichtungen oder Lebensmittel verarbeitenden  Institutionen arbeiten</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Patienten,  die in Gemeinschaftseinrichtungen oder Lebensmittel verarbeitenden  Institutionen arbeiten</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei  Personen mit stattgehabter</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Antibiotika</span>]</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">-Einnahme innerhalb der letzten 3 Monate</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei  Personen mit stattgehabter</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Antibiotika</span>]</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">-Einnahme innerhalb der letzten 3 Monate</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Nach  Fernreise</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Nach  Fernreise</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei Durchfällen > 5 Tage, blutiger Diarrhoe, bei schweren  Verläufen oder Gruppenerkrankungen:</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei Durchfällen > 5 Tage, blutiger Diarrhoe, bei schweren  Verläufen oder Gruppenerkrankungen:</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Basisdiagnostik  Stuhl (s.o.)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Basisdiagnostik  Stuhl (s.o.)</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Enteropathogene ''E.  coli'' (PCR)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Enteropathogene ''E.  coli'' (PCR)</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Protozoen  (Amöben, Lamblien) aus drei unabhängigen Stuhlproben</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Protozoen  (Amöben, Lamblien) aus drei unabhängigen Stuhlproben</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Zusätzlich  bei Fieber: Blutkulturen (mindesten zwei) UND</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Malaria_und_andere_parasit%C3%A4re_Infektionen#Malaria <span class="ve-pasteProtect" style="color: #0B0080" data-ve-attributes="{&quot;style&quot;:&quot;color: #0B0080&quot;}">Malaria</span>]</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">-Diagnostik (wenn zum Reiseland passend)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Zusätzlich  bei Fieber: Blutkulturen (mindesten zwei) UND</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Malaria_und_andere_parasit%C3%A4re_Infektionen#Malaria <span class="ve-pasteProtect" style="color: #0B0080" data-ve-attributes="{&quot;style&quot;:&quot;color: #0B0080&quot;}">Malaria</span>]</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">-Diagnostik (wenn zum Reiseland passend)</span>
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Flüssigkeits-  und Eleketrolytausgleich,</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">· <span class="ve-pasteProtect" style="font:7.0pt &quot;Times New Roman&quot;" data-ve-attributes="{&quot;style&quot;:&quot;font:7.0pt \&quot;Times New Roman\&quot;&quot;}">         </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  primär empirische antimikrobielle Therapie</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Flüssigkeits-  und Eleketrolytausgleich,</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">· <span class="ve-pasteProtect" style="font:7.0pt &quot;Times New Roman&quot;" data-ve-attributes="{&quot;style&quot;:&quot;font:7.0pt \&quot;Times New Roman\&quot;&quot;}">         </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  primär empirische antimikrobielle Therapie</span>


<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">· <span class="ve-pasteProtect" style="font:7.0pt &quot;Times New Roman&quot;" data-ve-attributes="{&quot;style&quot;:&quot;font:7.0pt \&quot;Times New Roman\&quot;&quot;}">         </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  motilitätshemmende Therapie</span>
<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">· <span class="ve-pasteProtect" style="font:7.0pt &quot;Times New Roman&quot;" data-ve-attributes="{&quot;style&quot;:&quot;font:7.0pt \&quot;Times New Roman\&quot;&quot;}">         </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  motilitätshemmende Therapie</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei blutiger Diarrhoe, Fieber oder Risikopatienten  (Immunsuppression):</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei blutiger Diarrhoe, Fieber oder Risikopatienten  (Immunsuppression):</span>


* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">2 x 500 mg oral für 3-5 Tage  (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">2 x 500 mg oral für 3-5 Tage  (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage)</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>] 1x 500 mg p.o. für 3 Tage  (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>] 1000 mg einmalig</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>] 1x 500 mg p.o. für 3 Tage  (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>] 1000 mg einmalig</span>




<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei  dringendem V.a. eine Infektion mit Amöben:</span>
<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei  dringendem V.a. eine Infektion mit Amöben:</span>


* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Metronidazol <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Metronidazol</span>] 3x 10 mg/kg KG/Tag (max 3x 800 mg)  oral oder i.v. für 10 Tage</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Metronidazol <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Metronidazol</span>] 3x 10 mg/kg KG/Tag (max 3x 800 mg)  oral oder i.v. für 10 Tage</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Isolation bei Krankenhausaufnahme bis 48h durchfallfrei</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Isolation bei Krankenhausaufnahme bis 48h durchfallfrei</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Nosokomial  erworben (>72h stationär) oder ambulant erworben plus</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Nosokomial  erworben (>72h stationär) oder ambulant erworben plus</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Immunsuppression  und/oder</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Immunsuppression  und/oder</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Zeichen  der schweren Dehydratati</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">on/[https://abbuch.uk-koeln.de/index.php/Sepsis <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Sepsis</span>]</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Zeichen  der schweren Dehydratati</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">on/[https://abbuch.uk-koeln.de/index.php/Sepsis <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Sepsis</span>]</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Basisdiagnostik  Stuhl: Norovirus, Rotavirus, Adenovirus, Enteropathogene ''E. coli'', ''C.  difficile'', Salmonellen, Shigellen, Campylobacter, Yersinien</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Basisdiagnostik  Stuhl: Norovirus, Rotavirus, Adenovirus, Enteropathogene ''E. coli'', ''C.  difficile'', Salmonellen, Shigellen, Campylobacter, Yersinien</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Abnahme  von 2 Pärchen Blutkulturen</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Abnahme  von 2 Pärchen Blutkulturen</span>
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Flüssigkeits-  und Elekrolytausgleich</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Flüssigkeits-  und Elekrolytausgleich</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  primär empirische antimikrobielle Therapie</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">keine  primär empirische antimikrobielle Therapie</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">häufig selbstlimitierend</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">häufig selbstlimitierend</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei schweren Verläufen oder Verläufe >3 Tage (NACH Abnahme  der Stuhldiagnostik):</span>
|<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bei schweren Verläufen oder Verläufe >3 Tage (NACH Abnahme  der Stuhldiagnostik):</span>


* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">2x 500 mg oral für 3-5 Tage oder</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">2x 500 mg oral für 3-5 Tage oder</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">1x 500 mg oral für 3 Tage</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Azithromycin</span>]</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">1x 500 mg oral für 3 Tage</span>
* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">(alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ceftriaxon <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ceftriaxon</span>] 1x 2g i.v. für 3-5 Tage)</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">(alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ceftriaxon <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ceftriaxon</span>] 1x 2g i.v. für 3-5 Tage)</span>
|
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* <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Isolation bei Krankenhausaufnahme bis 48h durchfallfrei</span>
*<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Isolation bei Krankenhausaufnahme bis 48h durchfallfrei</span>
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Revision as of 21:55, 12 December 2020

Erreger

Akute Diarrhoen ohne Erregernachweis

Klinische Situationen Diagnostik Therapie 1. Wahl Therapie 2. Wahl Komplikationen/Hygiene Hinweise/Meldepflicht
  • Ambulant erworben (≤72h stationär)
  • Keine Immunsuppression
  • Keine Zeichen der schweren Dehydratation/Sepsis


 Spezifische Diagnostik nicht regelhaft notwendig*Typische Erreger: Diversive Viren, Enteropathogene E. coli, C. difficile, Salmonellen, Shigellen, Campylobacter und Yersinien
  • Ambulante, supportive Therapie mit oraler Flüssigkeits- und Elekrolytzufuhr
  • Keine empirische antimikrobielle Therapie
  • Häufig selbstlimitierend
 -
  • *In folgenden Untergruppen ist eine Diagnostik notwendig:
  • Blutige Diarrhö
  • Patienten, die in Gemeinschaftseinrichtungen oder Lebensmittel verarbeitenden Institutionen arbeiten
  • Bei Personen mit stattgehabter Antibiotika-Einnahme innerhalb der letzten 3 Monate
  • Nach Fernreise
  • Bei Durchfällen > 5 Tage, blutiger Diarrhoe, bei schweren Verläufen oder Gruppenerkrankungen:
  • Basisdiagnostik Stuhl (s.o.)
  • Enteropathogene E. coli (PCR)
  • Protozoen (Amöben, Lamblien) aus drei unabhängigen Stuhlproben
  • Zusätzlich bei Fieber: Blutkulturen (mindesten zwei) UND Malaria-Diagnostik (wenn zum Reiseland passend)
 Flüssigkeits- und Eleketrolytausgleich,·         keine primär empirische antimikrobielle Therapie

·         keine motilitätshemmende Therapie

Bei blutiger Diarrhoe, Fieber oder Risikopatienten (Immunsuppression):


Bei dringendem V.a. eine Infektion mit Amöben:

  • Metronidazol 3x 10 mg/kg KG/Tag (max 3x 800 mg) oral oder i.v. für 10 Tage
  • Isolation bei Krankenhausaufnahme bis 48h durchfallfrei
  • Nosokomial erworben (>72h stationär) oder ambulant erworben plus
  • Immunsuppression und/oder
  • Zeichen der schweren Dehydratation/Sepsis
  • Basisdiagnostik Stuhl: Norovirus, Rotavirus, Adenovirus, Enteropathogene E. coli, C. difficile, Salmonellen, Shigellen, Campylobacter, Yersinien
  • Abnahme von 2 Pärchen Blutkulturen
  • Flüssigkeits- und Elekrolytausgleich
  • keine primär empirische antimikrobielle Therapie
  • häufig selbstlimitierend
 Bei schweren Verläufen oder Verläufe >3 Tage (NACH Abnahme der Stuhldiagnostik):
  • Isolation bei Krankenhausaufnahme bis 48h durchfallfrei
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