DGI:ZNS-Infektionen/Tuberkulose Meningitis/Therapie: Difference between revisions

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==Therapie==
{| class="wikitable "
{| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: "Open Sans", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{"style":"box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \"Open Sans\", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;"}"
|+
|+
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">'''Klinische <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Situation</span>'''</span>
|+<span id="Tabelle 2: First line Medikamente zur Behandlung der Tbc">Tabelle 2: First line Medikamente zur Behandlung der Tbc</span>
! class="col-grey-light-bg" style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Präferenz'''</span>
!Klinische Situation
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Substanz'''</span>
!Präferenz
! class="col-grey-light-bg" style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dosierung'''</span>
!Substanz
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dauer'''</span>
!Dosierung
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Anpas-sungen'''</span>
!Dauer
! class="col-grey-light-bg" style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Liquor- Gängig-keit'''</span>
!Liquor Gängigkeit
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|-
| rowspan="3" style="" data-ve-attributes="{&quot;style&quot;:&quot;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Tuberkulöse Meningitis</span>
! rowspan="6" scope="row" |Tuberkulöse Meningitis
| rowspan="2" style="" data-ve-attributes="{&quot;style&quot;:&quot;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Therapie der Wahl</span>
| rowspan="4" scope="row" |Therapie der Wahl
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Rifampicin</span>
|Rifampicin
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">10 mg/kg KG, max 600 mg</span>
|10 mg/kg KG, max 600 mg
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">12 Monate</span>
|12 Monate
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
|10-20%
| style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">10-20%</span>
|-
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|-  
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Isoniazid</span>
|Isoniazid
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Pyrazinamid</span>
|5 mg/kg KG
 
|12 Monate
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ethambutol</span>
|80-90%
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">5 mg/kg KG</span>
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">25 mg/kg KG</span>
|-
 
|Pyrazinamid
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">15 mg/kg KG</span>
|25 mg/kg KG
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">12 Monate</span>
|Ersten 2 Monate
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ersten</span>
|90-100%
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">2 Monate</span>
|-
 
|Ethamutolb
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ersten</span>
|*15 mg/kg KG
|Ersten 2 Monate
|20-30%
|-
|-  
|Zusatz
|Vitamin B6 <ref>Amagon KI, Awodele O, Akindele AJ. Methionine and vitamin B-complex ameliorate antitubercular drugs-induced toxicity in exposed patients. Pharmacol Res Perspect. 2017;5(5). doi:10.1002/prp2.360</ref>
|40 mg/d
|Mit INH
| -
|}


<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">2 Monate</span>
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
| style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">80-90%</span>
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">90-100%</span>


<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">20-30%</span>
{| class="wikitable "
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
| style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Zusatz</span>
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Vitamin B6 <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[9]</span></span>
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">40 mg/d</span>
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">mit INH</span>
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
| style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
|}
Tabelle 2: First line Medikamente zur Behandlung der Tbc
{| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: &quot;Open Sans&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \&quot;Open Sans\&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;&quot;}"
|+
|+
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">'''Klinische Situation'''</span>
|+<span id="Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc">Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc</span>
! class="col-grey-light-bg" style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Präferenz'''</span>
!Klinische Situation
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Substanz'''</span>
!Substanz
! class="col-grey-light-bg" style="width:77.95pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:77.95pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dosierung'''</span>
!Dosierung
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dauer'''</span>
!Dauer
! class="col-grey-light-bg" style="width:49.6pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.6pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Anpas-sungen'''</span>
!Liquor Gängigkeit
! colspan="2" class="col-grey-light-bg" style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Liquor Gängig-keit'''</span>
|-
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
! rowspan="8" scope="row" |Tuberkulöse Meningitis
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">Tuberkulöse Meningitis</span>
| rowspan="8" scope="row" |Second line
| style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |Second line
|Levofloxacin
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |Levofloxacin
|10-15 mg/kg
Moxifloxacin
|Durchgängig
 
|70-80%
Amikacin
|-
 
|-
Kanamycin
|Moxifloxacin
 
|400mg
Capreomycin
|Durchgängig
 
|70-80%
Ethionamid
|-
 
|-
Cycloserin
|Amikacin
 
|15 mg/kg, max 1g i.v.
Linezolid
|Intensivphase
| style="width:77.95pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:77.95pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">10-15 mg/kg</span>
|10-20%
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">400mg</span>
|-
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">15 mg/kg,</span>
|Kanamycin
 
|15 mg/kg, max 1g i.v.
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">max 1g i.v.</span>
|Intensivphase
 
|10-20%
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">15 mg/kg,</span>
|-
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">max 1g i.v.</span>
|Capreomycin
 
|15 mg/kg, max 1g i.v.
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">15 mg/kg,</span>
|Intensivphase
 
|Keine Daten
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">max 1g i.v.</span>
|-
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">15-20 mg/kg,</span>
|Ethionamid
 
|15-20 mg/kg, max 1g i.v.
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">max 1g i.v.</span>
|durchgängig
 
|80-90%
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">10-20 mg/kg,</span>
|-
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">max 1g i.v.</span>
|Cycloserin
 
|10-20 mg/kg, max 1g i.v.
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">600 mg</span>
|durchgängig
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">durch-gängig</span>
|80-90%
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">Intensiv-</span>
|-
 
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}">phase</span>
|Linezolid
| style="width:49.6pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.6pt;&quot;}" |
|600 mg
| style="width:48.8pt;" width="65" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:48.8pt;&quot;}" |70-80%
|durchgängig
70-80%
|30-70%
 
|-
10-20%
|-
 
10-20%
 
80-90%
 
80-90%
 
30-70%
| style="" width="1" data-ve-attributes="{&quot;style&quot;:&quot;&quot;}" |
|}
|}
Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Zusätzlich zur antituberkulösen Chemotherapie <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[1, 2, 5, 7]</span></span> <span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">sollte Dexamethason oder Prednisolon verabreicht werden. Für Deutschland wird in Übereinstimmung mit den NICE-Empfehlungen beim Erwachsenen (> 15 Jahre) eine Prednisolon-Dosis von 40 mg/Tag (ohne RMP-Gabe: 20 mg/Tag) empfohlen, welche nach 2-3 Wochen um jeweils 10 mg/Woche reduziert und dann beendet werden kann <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[10, 11]</span>.</span>


MDR = multi-drug resistance, RMP = Rifampicin
Zusätzlich zur antituberkulösen Chemotherapie <span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Schaberg T, Bauer T, Brinkmann F, et al. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-397. doi:10.1055/s-0043-105954</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-187. doi:10.1016/j.jinf.2009.06.011</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4(3):199-205. doi:10.1212/CPJ.0000000000000023</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span> sollte Dexamethason oder Prednisolon verabreicht werden. Für Deutschland wird in Übereinstimmung mit den NICE-Empfehlungen beim Erwachsenen (> 15 Jahre) eine Prednisolon-Dosis von 40 mg/Tag (ohne RMP-Gabe: 20 mg/Tag) empfohlen, welche nach 2-3 Wochen um jeweils 10 mg/Woche reduziert und dann beendet werden kann <span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2016;4:CD002244. doi:10.1002/14651858.CD002244.pub4</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span><ref>Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351(17):1741-1751. doi:10.1056/NEJMoa040573</ref><span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"></span></span>.

Latest revision as of 19:55, 9 August 2021

Tabelle 2: First line Medikamente zur Behandlung der Tbc
Klinische Situation Präferenz Substanz Dosierung Dauer Liquor Gängigkeit
Tuberkulöse Meningitis Therapie der Wahl Rifampicin 10 mg/kg KG, max 600 mg 12 Monate 10-20%
Isoniazid 5 mg/kg KG 12 Monate 80-90%
Pyrazinamid 25 mg/kg KG Ersten 2 Monate 90-100%
Ethamutolb *15 mg/kg KG Ersten 2 Monate 20-30%
Zusatz Vitamin B6 [1] 40 mg/d Mit INH -


Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc
Klinische Situation Substanz Dosierung Dauer Liquor Gängigkeit
Tuberkulöse Meningitis Second line Levofloxacin 10-15 mg/kg Durchgängig 70-80%
Moxifloxacin 400mg Durchgängig 70-80%
Amikacin 15 mg/kg, max 1g i.v. Intensivphase 10-20%
Kanamycin 15 mg/kg, max 1g i.v. Intensivphase 10-20%
Capreomycin 15 mg/kg, max 1g i.v. Intensivphase Keine Daten
Ethionamid 15-20 mg/kg, max 1g i.v. durchgängig 80-90%
Cycloserin 10-20 mg/kg, max 1g i.v. durchgängig 80-90%
Linezolid 600 mg durchgängig 30-70%

Zusätzlich zur antituberkulösen Chemotherapie [2][3][4][5] sollte Dexamethason oder Prednisolon verabreicht werden. Für Deutschland wird in Übereinstimmung mit den NICE-Empfehlungen beim Erwachsenen (> 15 Jahre) eine Prednisolon-Dosis von 40 mg/Tag (ohne RMP-Gabe: 20 mg/Tag) empfohlen, welche nach 2-3 Wochen um jeweils 10 mg/Woche reduziert und dann beendet werden kann [6][7].

  1. ↑ Amagon KI, Awodele O, Akindele AJ. Methionine and vitamin B-complex ameliorate antitubercular drugs-induced toxicity in exposed patients. Pharmacol Res Perspect. 2017;5(5). doi:10.1002/prp2.360
  2. ↑ Schaberg T, Bauer T, Brinkmann F, et al. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-397. doi:10.1055/s-0043-105954
  3. ↑ Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120
  4. ↑ Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-187. doi:10.1016/j.jinf.2009.06.011
  5. ↑ Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4(3):199-205. doi:10.1212/CPJ.0000000000000023
  6. ↑ Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2016;4:CD002244. doi:10.1002/14651858.CD002244.pub4
  7. ↑ Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351(17):1741-1751. doi:10.1056/NEJMoa040573
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