DGI:Knochen-, Gelenks- und Protheseninfektionen/Hämatogene Osteomyelitis/Therapie: Difference between revisions

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===Kalkulierte Therapie===


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{{Hinweis/CAVE|text=Wann immer möglich: Therapiebeginn erst nach Erregernachweis.Vor Therapiebeginn immer mikrobiologische Diagnostik (Blutkulturen, Knochenbiopsie) veranlassen.}}
| style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Erreger'''</span>
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Präferenz'''</span>
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Substanz'''</span>
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Dosierung'''</span>
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |<span class="mw-collapsible-toggle mw-collapsible-toggle-default" role="button" tabindex="0" style="box-sizing: inherit; cursor: pointer; float: right; user-select: none;">Einklappen</span><span style="box-sizing: inherit; font-size: 9pt;">'''Kommentar'''</span>
|- style="box-sizing: inherit;"
| rowspan="13" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Staphylococcus aureus
und andere Staphylokokken,


Oxacillin-sensibel
Eine kalkulierte Therapie sollte bei klinisch instabilen, septischen Patient:innen begonnen werden.
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
1. Wahl
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Flucloxacillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Cefazolin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 2 g i.v.
|- style="box-sizing: inherit;"
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Alternative bei schwerer Allergie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |*
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
<nowiki>**</nowiki> hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 8 – 10** mg/kg i.v.
|- style="box-sizing: inherit;"
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |bei Fremdmaterial-assoziierter Infektion
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">plus</span>
<span style="box-sizing: inherit;">Rifampicin</span>
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 600 mg i.v. bzw.
2 x 450 mg p.o.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |wegen sehr guter Bioverfügbarkeit orale Gabe bevorzugen
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |alternativ
plus


Fosfomycin <span style="box-sizing: inherit;">           </span>
Für die kalkulierte Therapie bei der hämatogenen Osteomyelitis: s. Kapitel „[[Knochen-, Gelenks- und Protheseninfektionen/Spondylodiszitis|Spondylodiscitis]]“.
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 5 g i.v.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="4" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
''ohne'' Fremdmaterial
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Cotrimoxazol
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 960 mg p.o
| rowspan="4" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |'''Cave:''' wegen schlechter Bioverfügbarkeit orale Betalaktame meiden.
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Clindamycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 600 mg p.o
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Doxycyclin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 100 mg p.o.
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Levofloxacin


plus
Bei Osteomyelitis per continuitatem: s. Kapitel “[[Knochen-, Gelenks- und Protheseninfektionen/Diabetischer Fuß|Diabetischer Fuß]]”.
 
Rifampicin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 500 mg p.o.
plus
 
2 x 450 mg p.o.
|- style="box-sizing: inherit;"
| rowspan="3" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
bei ''Fremdmaterial''-assoziierter Infektion
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Cotrimoxazol
plus
 
Rifampicin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 960 mg p.o.
plus
 
2 x 450 mg p.o.
| rowspan="3" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |möglichst keine Kombination von Rifampicin mit Clindamycin oder Linezolid
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Doxycyclin
 
plus
 
Rifampicin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 100 mg p.o.
plus
 
2 x 450 mg p.o.
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Levofloxacin
 
plus
 
Rifampicin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 500 mg p.o.
plus
 
2 x 450 mg p.o.
|- style="box-sizing: inherit;"
| rowspan="5" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Staphylococcus aureus
und andere Staphylokokken,
 
Oxacillin-resistent
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |*
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
<nowiki>**</nowiki> hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 8 – 10** mg/kg i.v.
|- style="box-sizing: inherit;"
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |bei ''Fremdmaterial''-assoziierter Infektion
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">plus</span>
<span style="box-sizing: inherit;">Rifampicin</span>
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 600 mg i.v. bzw.
2 x 450 mg p.o.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |wegen sehr guter Bioverfügbarkeit orale Gabe bevorzugen
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |alternativ
plus
 
Fosfomycin <span style="box-sizing: inherit;">           </span>
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 5 g i.v.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| colspan="3" style="width:432.35pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="576" valign="top" |s.oben
|- style="box-sizing: inherit;"
| rowspan="4" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Enterococcus spp.,
Ampicillin-sensibel
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
1.Wahl
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ampicillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Alternativen
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |'''*'''
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 10 - 12 mg/kg <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="0" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="1" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span> i.v.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Amoxicillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 1 g p.o.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="3" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Enterococcus spp.,
Ampicillin-resistent
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |'''*'''
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 10 - 12 mg/kg <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="2" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="3" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span> i.v.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Linezolid
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 600 mg p.o.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |Linezolid max. 28 Tage zugelassen
|- style="box-sizing: inherit;"
| rowspan="2" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Streptokokken
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Benzylpenicillin (Penicillin G)
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">4 x 5 Mio I.E. i.v.                                    </span>
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Amoxicillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">3 x 1 g p.o.</span>
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="3" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Enterobakterien
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ampicillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ceftriaxon
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 2 g i.v.
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ciprofloxacin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 750 mg p.o
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="3" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Pseudomonas aeruginosa
| rowspan="2" style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Piperacillin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |4 x 4 g i.v.
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |Bei Pseudomonas-Infektionen immer hohe Dosis verwenden.
|- style="box-sizing: inherit;"
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Ceftazidim
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 2 g i.v.
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ciprofloxacin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 750 mg p.o.
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="2" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Candida spp.
''<span style="box-sizing: inherit;">'''     '''</span>''
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Caspofungin
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |Tag 1: <span style="box-sizing: inherit;">                       </span>
1 x 70 mg i.v.,
 
danach: 1 x 50 mg i.v. <span style="box-sizing: inherit;">                <span style="box-sizing: inherit;"> </span></span><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="4" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="5" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span> ≤ 80 kg
 
bzw. 1 x 70 mg i.v. <span style="box-sizing: inherit;">           </span> <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="6" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="7" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span> > 80 kg
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Fluconazol
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">Einmalig 1 x 800 mg p.o.,</span>
<span style="box-sizing: inherit;">weiter mit 1 x 400 mg p.o.</span>
| style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="2" style="width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Mycobacterium tuberculosis
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Initialtherapie 2 Monate
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">Isoniazid (in Kombi mit Pyridoxin)</span>
plus Rifampicin plus Pyrazinamid plus Ethambutol
| style="width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |s. Dosierungsempfehlung Link Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose
| rowspan="2" style="width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">Isoniazid (in Kombi mit Pyridoxin)</span>
<span style="box-sizing: inherit;">plus R</span>ifampicin
|}

Latest revision as of 10:11, 4 April 2022

Kalkulierte Therapie

CAVE: Wann immer möglich: Therapiebeginn erst nach Erregernachweis.Vor Therapiebeginn immer mikrobiologische Diagnostik (Blutkulturen, Knochenbiopsie) veranlassen.


Eine kalkulierte Therapie sollte bei klinisch instabilen, septischen Patient:innen begonnen werden.

Für die kalkulierte Therapie bei der hämatogenen Osteomyelitis: s. Kapitel „Spondylodiscitis“.

Bei Osteomyelitis per continuitatem: s. Kapitel “Diabetischer Fuß”.

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