DGI:Geschlechtskrankheiten/Therapie: Difference between revisions

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==Therapie==
{| class="wikitable sortable mw-collapsible MsoTableGrid" style="width:488.8pt;" border="1" cellspacing="0" cellpadding="0" width="652"
|+
| style="width:212.4pt;" width="283" valign="top" |'''<span style="font-size:11.0pt;line-height:150%;font-family:&quot;Arial&quot;,sans-serif;
  mso-fareast-language:DE">Herpes simplex Typ 1 und 2</span>'''


<span style="color: black">Primärinfektion</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Aciclovir 3-4x 400mg oder 5x 200mg 5-7 Tage p.o.</span>
*Valaciclovir 2x 500mg 7-10  Tage p.o.
*Famciclovir 3x 250mg 7-10  Tage p.o.
|- style="height:77.8ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Reaktivierung</span>
| style="width:276.4pt;" width="369" valign="top" |
*Aciclovir 2x 800mg oder 3x  400mg oral 5 Tage p.o.
*Aciclovir 3x 800mg 2 Tage p.o.
*Valaciclovir 2x 500mg 3-5  Tage p.o.
*Valaciclovir 1x1g 5 Tage  p.o.
*Famciclovir 2x  125mg 5 Tage
|- style="height:20.8ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Schwangere</span>
|Primärinfektion:
* Aciclovir 5x 200mg 10 Tage p.o.
Reaktivierung:
* Aciclovir 3x 400mg 10 Tage p.o.
Aciclovir ist in der SS nicht zugelassen. Die Gabe vor der 14. SSW sollte vermieden werden.
|- style="height:41.9ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Dauertherapie</span>
<span style="color: black">(bis 6 Monate)</span>
| style="width:276.4pt;" width="369" valign="top" |
*Aciclovir 2x 400mg p.o.
*Famciclovir 2x 250mg p.o.
*Valaciclovir 1x 500mg p.o.
|- style="height:166.7ptpx;"
| style="width:212.4pt;" width="283" valign="top" |'''<span style="color: black">Gonorrhoe</span>''' <sup><span style="color: #0070C0">[13</span></sup><ref><span style="font-family:&quot;Arial&quot;,sans-serif;
mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">059/004 S2k-Leitlinie: Diagnostik und Therapie der Gonorrhoe, Stand 12/2018</span></ref><sup><span style="color: #0070C0">,14</span></sup><ref>Buder, S.et al., Antimicrobial resistance of Neisseria gonorrhoea in Germany: low levels of cephalosporin resistance, but high azithromycin resistance, BMC Infectious Diseases. 2018 (18); 44.</ref><sup><span style="color: #0070C0">,15</span></sup><ref>Day, M.J., et al., Stably high azithromycin resistance and decreasing ceftriaxon susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016. BMC Infectious Diseases. 2018 (18); 609.</ref><sup><span style="color: #0070C0">]</span></sup>
'''<span style="color: black">(Neisseria  gonorrhoea)</span>'''<sup><span style="color: #0070C0"> </span></sup>
<span style="color: black">Urogenital, Pharynx, Rektum</span>
| style="width:276.4pt;" width="369" valign="top" |<span style="color: black">Empirisch bei nicht  auszuschliessender Begleitinfektion:</span>
*<span style="color: black">Ceftriaxon 1-2g i.v. oder i.m. Tag 1</span>
<span style="color: black">+ Azithromycin 1,5g oral Tag 1</span>
<span style="color: black">nach Anschluss einer Begleitinfektion:</span>
*<span style="color: black">Ceftriaxon 1-2g i.v. oder i.m. Tag 1</span>
<span style="color: black">Alternativen bei  nachgewiesener Empfindlichkeit (Kultur):</span>
* bei urogenitalem/rektalem Befall: Azithromycin 2g  Tag 1 p.o.  PLUS
*<span style="color: black">Cefixim 800mg Tag 1 p.o.</span>
Bei Ausschließlich pharyngealem Befall:
<span style="color: black"><span style="mso-char-type:symbol;mso-symbol-font-family:Symbol">±</span></span><span style="color: black"> Azithromycin 1,5g Tag 1  p.o.</span>
|- style="height:91.1ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Schwangerschaft</span><br />
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Ceftriaxon 1g i.v. oder i.m. Tag 1</span>
<span style="color: black">nur bei  Kontraindikation gegen Ceftriaxon und nachgewiesener Empfindlichkeit:</span>
*Azithromycin 2g Tag 1 p.o.
|- style="height:20.8ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Kinder</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Bis 45kg KG Ceftriaxon 20-50mg/kg KG i.v. oder i.m. Tag 1</span>
|- style="height:35.95ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Disseminierte Gonokokkeninfektion</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Ceftriaxon 2g alle 24 Stunden 7 Tage i.v. oder i.m. <span style="mso-spacerun:yes">                          </span>+ Azithromycin  1,5g Tag 1 p.o.</span>
|- style="height:134.15ptpx;"
| style="width:212.4pt;" width="283" valign="top" |'''<span style="color: #333333">Chlamydia trachomatis </span>'''<sup><span style="color: #0070C0">[8</span></sup><ref>059/005 S2k-Leitlinie: Infektionen mit Chlamydia trachomatis, Stand 08/2016.</ref><sup><span style="color: #0070C0">]</span></sup>
<span style="color: black">Urogenital,  Pharynx, Rektum</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x 100mg 7 Tage p.o.</span>
<span style="color: black">Alternativ nach Ausschluss  Serotyp L1-3 bei Proktitis</span><span style="color: black">:</span>
*<span style="color: black">Azithromycin 1,5g Tag 1 p.o.</span>
<span style="color: black">bei synchroner Infektion  mit Gonokokken:</span>
*<span style="color: black">Ceftriaxon 1-2g Tag 1 i.v. oder i.m.</span>
<span style="color: black">+ Azithromycin 1,5g Tag 1 p.o.</span>
|- style="height:77.5ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Lymphogranuloma venereum (</span><span style="color: black">Serotyp L1-L3)</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x 100mg 21 Tage p.o.</span>
<span style="color: black">Alternativ:</span>
*Azithromycin 1,5g Tag 1,8,15  p.o.
*Erythromycin 4x 500mg 21  Tage p.o.
|- style="height:64.55ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Prostatitis</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x 100mg 7 Tage p.o.</span>
<span style="color: black">Alternativ:</span>
*Levofloxacin 1x 500mg 7 Tage  p.o.
|- style="height:59.55ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Epididymitis</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x 100mg 14 Tage p.o.</span>
<span style="color: black">Alternativ:</span>
*Levofloxacin 1x 500mg 7 Tage  p.o.
|- style="height:39.35ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Konjunktivitis</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x 100mg 7 Tage p.o.</span>
*<span style="color: black">Azithromycin 1,5g Tag 1 p.o.</span>
|- style="height:81.9ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Schwangerschaft</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Azithromycin 1,5g Tag 1 p.o.</span>
*<span style="color: black">Doxycyclin ab 16. SSW ''kontraindiziert''</span>
<span style="color: black">Alternativ:</span>
*Erythromycin 500mg 4x tgl.  oral 7 Tage
|- style="height:41.9ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Kinder</span>
| style="width:276.4pt;" width="369" valign="top" |<span style="color: black">Kinder <  45kg KG:</span>
*Erythromycin 10mg/kg KG 4x  tgl. 14 Tage p.o.
<span style="color: black">Kinder ab 8  Jahren > 45kg KG:</span>
<span style="color: black">Doxycyclin 200mg Tag 1, 100mg Tag 2-7</span>
|-
|Therapie Syphilis - allgemein
|Bei der Therapie der Syphilis kann es durch den Zerfall von Erregern nach dem Start der AB-Therapie in den ersten 48 h zu einer sog. Jarisch-Herxheimer-Reaktion kommen. Freigesetzte Endotoxine können Schüttelfrost, Fieber, Exantheme, Gelenkschwellungen etc. machen.
Um die Reaktion zu verhindern bzw. die Symptome zu minimieren, sollte einmalig VOR DER GABE der ERSTEN Antibiotikadosis ab Stadium II (Spätsyphilis)
<span style="color: black">PREDNISOLON 1 mg/kgKG p.o. </span>verabreicht werden<br />
|- style="height:125.6ptpx;"
| style="width:212.4pt;" width="283" valign="top" |'''<span style="color: black">Syphilis (Treponema  pallidum)</span>''' <sup><span style="color: #0070C0">[16</span></sup><ref>RKI-Ratgeber Syphilis (2003). Available online at: <nowiki>https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Syphilis.html#doc2382636bodyText8</nowiki></ref><sup><span style="color: #0070C0">]</span></sup>
<span style="color: black">Frühsyphilis  (< 1 Jahr)</span>
| style="width:276.4pt;" width="369" valign="top" |
*Benzathin-Penicillin G 2,4 Mio. IE i.m.
<span style="mso-spacerun:yes">       </span><span style="color: #333333">(jeweils 1,2 Mio. IE glutetal links/rechts)</span>
<span style="color: #333333">bei  Penicillinallergie'':''</span>
*<span style="color: #333333">Ceftriaxon 1x 2g 10 Tage i.v. Doxycyclin 2x 100mg 14 Tage p.o.</span>
*Erythromycin  4x 0,5g 14 Tage p.o.
|- style="height:4.0cmpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Spätsyphilis (> 1 Jahr) o.</span>
<span style="color: black">unbekannter Infektionszeitpunkt</span>
| style="width:276.4pt;" width="369" valign="top" |
*Benzathin-Penicillin G 2,4 Mio. IE <span style="color: black">Tag 1,8,15 </span>i.m.
<span style="color: #333333"><span style="mso-spacerun:yes">       </span>(jeweils 1,2 Mio. IE glutetal links/rechts)</span>
<span style="color: #333333">bei  Penicillinallergie:</span>
*<span style="color: #333333">Ceftriaxon 1x 2g 10-14 Tage i.v.</span>
*<span style="color: #333333">Doxycyclin 2x 100mg 28 Tage p.o.</span>
*<span style="color: #333333">Erythromycin 4x 0,5g/Tag 28 Tage p.o.</span>
|- style="height:4.0cmpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Neurosyphilis</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Benzylpenicillin G  i.v.</span>
<span style="color: black">(5 Mio  IE 5x tgl. </span><span style="color: black"><span style="mso-char-type:symbol;mso-symbol-font-family:Symbol">³</span></span><span style="color: black"> 14 Tage)</span>
<span style="color: black">(6 Mio  IE 4x tgl. </span><span style="color: black"><span style="mso-char-type:symbol;mso-symbol-font-family:Symbol">³</span></span><span style="color: black"> 14 Tage)</span>
<span style="color: black">(10 Mio IE 3x tgl. </span><span style="color: black"><span style="mso-char-type:symbol;mso-symbol-font-family:Symbol">³</span></span> <span style="color: black">14 Tage)</span>
<span style="color: #333333">bei  Penicillinallergie:</span>
*<span style="color: #333333">Ceftriaxon 2g i.v. 14 Tage i.v.</span>
*<span style="color: #333333">Doxycyclin 2x 200mg 28 Tage p.o.</span>
|- style="height:47.85ptpx;"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Kinder</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: #333333">Therapie wie bei Erwachsenen</span>
*Dosis: Benzathin-Penicillin G 50.000 IE/kg KG i.m.
*<span style="color: #333333">CAVE: kein Doxycyclin unter 8 Jahren</span>
|- style="mso-yfti-irow:19"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: black">Schwangere</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: #333333">Therapie wie bei Nicht-Schwangeren</span>
*<span style="color: black">Doxycyclin ab 16. SSW kontraindiziert</span>
|- style="mso-yfti-irow:20"
| style="width:212.4pt;" width="283" valign="top" |'''<span style="color: #333333">Trichomonas vaginalis</span>'''
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Metronidazol 2x 500mg 7 Tage p.o. <span style="mso-spacerun:yes">                              </span></span>
*<span style="color: black">Metronidazol 2g Tag 1 p.o.</span>
|- style="mso-yfti-irow:21"
| style="width:212.4pt;" width="283" valign="top" |'''<span style="color: black">Mollicutes</span>'''
<span style="color: #333333">Mykoplasma genitalium (Urethritis)</span>
<sup><span style="color: #0070C0">[10</span></sup><ref>Jensen, J.S., et al., European guideline on Mycoplasma genitalium infections. Journal of the European Academy of Dermatology and Venereology. 2016;30: p1650-56.</ref><sup><span style="color: #0070C0">,17</span></sup><ref>Sethi S, Zaman K, Jain N. Mycoplasma genitalium infections: current treatment options and resistance issues. Infect Drug Resist. 2017;10:283-292
<nowiki>https://doi.org/10.2147/IDR.S105469</nowiki></ref><sup><span style="color: #0070C0">]</span></sup>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Azithromycin 1g Tag 1, dann 500mg Tag 2-5 p.o.</span>
*<span style="color: black">Azithromycin 1,5-2g Tag 1 p.o. <span style="mso-spacerun:yes">                                               </span>+ Doxycyclin 2x 100mg 7 Tage p.o.</span>
<span style="color: black">bei Azithromycinresistenz:</span>
*Moxifloxacin  400mg 7-10 Tage p.o.
|- style="mso-yfti-irow:22"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Mykoplasma hominis</span>
| style="width:276.4pt;" width="369" valign="top" |<span style="color: black">nur bei  Symptomen und ausschließlichem Erregernachweis:</span>
*<span style="color: black">Metronidazol 2x 500mg 7 Tage p.o. <span style="mso-spacerun:yes">                              </span></span>
*<span style="color: black">Metronidazol 2g Tag 1 p.o.</span>
|- style="mso-yfti-irow:23"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Ureaplasma urealyticum</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 2x100mg 7 Tage p.o.</span>
Alternative: Clarithromycin 2x500mg p.o. für 5 d
|- style="mso-yfti-irow:24;mso-yfti-lastrow:yes"
| style="width:212.4pt;" width="283" valign="top" |<span style="color: #333333">Ureaplasma parvum</span>
| style="width:276.4pt;" width="369" valign="top" |
*<span style="color: black">Doxycyclin 200mg Tag 1 p.o.</span>
Clarithromycin 2x500 mg p.o. für 5 d
|}
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Latest revision as of 20:13, 16 June 2021

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