Lübbert C, Mutters R
Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
Internist (Berl). 2017 Feb;58(2):149-169. doi: 10.1007/s00108-016-0183-y.
Infectious diarrhea is one of the most common diseases. This article summarizes the current state of the diagnostics and treatment and includes the most important pathogens, i.e. Norovirus, Rotavirus, Campylobacter, Salmonella, Shigella and pathogenic Escherichia coli. Infections caused by toxin-producing strains of Clostridium difficile are described in more detail due to the increasing importance. Symptomatic therapy is still the most important component of treatment. Empirical antibiotic therapy is reserved for severely ill patients with a high stool frequency, fever, bloody diarrhea, underlying immune deficiency or significant comorbidities. Increasing bacterial resistance (in particular against fluoroquinolones) has to be considered. Motility inhibitors are not recommended for infections due to Shiga toxin-producing E. coli, C. difficile infections (CDI) and severe enterocolitis caused by other pathogens. The macrocyclic antibiotic fidaxomicin can reduce the recurrence rate of CDI. Fecal microbiota transplantation (FMT) currently provides a reserve treatment option for multiple recurrences of CDI and is subject to the Medicines Act (Arzneimittelgesetz, AMG) in Germany.
