View source for DGI:Gynäkologische Infektionen/Therapie

<span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">a) <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>'''<u>Bakterielle Vaginose</u>'''

Da es sich bei der BV um eine Dysbiose der Scheidenmilieus handelt ist eine spezifische Therapie eines Erregers meist nicht sinnvoll. Die Therapie mittels Metronidazol oder alternativ einer lokalen Therapie mittels einer Clindamycin-haltigen Vaginalcreme sind in der Regel ausreichend. Beachtung sollten Schwangere mit einem hohen Risiko für eine Frühgeburt erfahren.
===Kalkulierte Therapie===
<br />
{| class="wikitable sortable bs-exportable MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;" data-ve-attributes="{&quot;style&quot;:&quot;border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;&quot;}" cellspacing="0" cellpadding="0" border="1"
|+
! style="width:116.8pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |'''Diagnose'''
! style="width:116.8pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |'''Substanz'''
! style="width:116.8pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |'''Dosierung'''
! style="width:116.85pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:116.85pt;&quot;}" width="156" valign="top" |'''Dauer'''
|- style="mso-yfti-irow:1" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:1&quot;}"
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |BV außerhalb der Schwangerschaft
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |Metronidazol


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ</span>

Clindamycin
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |2x/500 mg p.o.
5g 2%ige Vaginalcreme
| style="width:116.85pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.85pt;&quot;}" width="156" valign="top" |7 Tage
|- style="mso-yfti-irow:2;mso-yfti-lastrow:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:2;mso-yfti-lastrow:yes&quot;}"
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |BV während der Schwangerschaft
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |Metronidazol


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ</span>

Clindamycin


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">oder</span>

Clindamycin
| style="width:116.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.8pt;&quot;}" width="156" valign="top" |2x/500 mg p.o.
5g 2%ige Vaginalcreme

2 x 300 mg p.o.
| style="width:116.85pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:116.85pt;&quot;}" width="156" valign="top" |7 Tage
|}
{{Hinweis/CAVE|text=Bei Hochrisikopatientinnen mit Frühgeburt in der Anamnese muss eine Prophylaxe als systemische Gabe erfolgen.}}

<span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{&quot;style&quot;:&quot;mso-list:Ignore&quot;}">b) <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>'''<u>Bartholinitis</u>'''

Zunächst erfolgt im frühen Stadium eine konservative Therapie mit lokalen Maßnahmen wie Kühlen sowie einer Antiphlogistischen und Analgetischen Mitteln.

Erst schwerere Verläufe werden mit einer Kombinationstherapie aus Amoxicillin und Metronidazol therapiert. Kommt es zu einer Abszessbildung ist eine chirurgische Intervention (Marsupialisation) notwendig. Bei Nachweis von Chlamydien muss diese Therapie entsprechend angepasst werden.

<br />
====Kalkulierte Therapie weiterer Erkrankungen/Infektionen====
{| class="wikitable sortable bs-exportable MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;" data-ve-attributes="{&quot;style&quot;:&quot;border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;&quot;}" cellspacing="0" cellpadding="0" border="1"
|+
! style="width:106.1pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |'''Diagnose'''
! style="width:5.0cm;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |'''Substanz'''
! style="width:148.8pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |'''Dosierung'''
! style="width:70.6pt;" class="col-grey-light-bg" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |'''Dauer'''
|- style="mso-yfti-irow:1" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:1&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Vulvitis pustulosa
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Cefuroxim


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ:</span>

Clindamycin
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |3 x 500mg p.o.
2 x 300mg p.o.
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |5 Tage
|- style="mso-yfti-irow:2" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:2&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Furunkel / Karbunkel
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |I.d.R. keine antibiotische Therapie  notwendig


falls doch:

Cefuroxim


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ:</span>

Clindamycin
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |3 x 500mg p.o.
2 x 300mg p.o
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |5 Tage
|- style="mso-yfti-irow:3" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:3&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Vulvitis durch
A-Streptokokken
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Penicillin V oder


Amoxicillin oder


Cefpodoxim


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ</span>:

Clindamycin
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |3 x 1 Mio bis 1,5 Mio IE p.o.
3 x 1000mg p.o.

2 x 200mg p.o.

2 x 300mg p.o.
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |10 Tage
10 Tage

7 - 10Tage

10 Tage
|- style="mso-yfti-irow:4" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:4&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Erythrasma
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Imidazol-Derivat lokal
Tetracyclin lokal
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |
|- style="mso-yfti-irow:5" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:5&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Bartholinitis
<span class="col-black">nur bei schweren  Verläufen</span>
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Amoxicillin
plus

Metronidazol


bei Gonokokken-Nachweis

Ceftriaxon
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |3 x 2000 mg p.o.
2 x 500 mg p.o.

1 x 2000 mg i.v.
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |7 Tage
7 Tage
|- style="mso-yfti-irow:6" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:6&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Kolpitis

*Trichomoniasis
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Metronidazol
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |1 x 2000mg p.o.
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |1 Tag
|- style="mso-yfti-irow:7" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:7&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Kolpitis

*ohne Erregernachweis
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Clindamycin
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |5g 2%ige Vaginalcreme
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |1 Tag
|- style="mso-yfti-irow:8" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:8&quot;}"
| style="width:106.1pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:106.1pt;&quot;}" width="141" valign="top" |Kolpitis

*A-Streptokokken
| style="width:5.0cm;" data-ve-attributes="{&quot;style&quot;:&quot;width:5.0cm;&quot;}" width="189" valign="top" |Penicillin V oder


Amoxicillin oder


Cefpodoxim


<span class="ve-pasteProtect" style="font-size:10.0pt" data-ve-attributes="{&quot;style&quot;:&quot;font-size:10.0pt&quot;}">alternativ</span>:

Clindamycin
| style="width:148.8pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:148.8pt;&quot;}" width="198" valign="top" |3 x 1 Mio bis 1,5 Mio IE p.o.
3 x 1000mg p.o.

2 x 200mg p.o.

2 x 300mg p.o.
| style="width:70.6pt;" data-ve-attributes="{&quot;style&quot;:&quot;width:70.6pt;&quot;}" width="94" valign="top" |10 Tage
10 Tage

7 - 10Tage

10 Tage
|}<br />