imported>Brinkery |
imported>Brinkery |
| Line 104: |
Line 104: |
| <span class="ve-pasteProtect" style="mso-ansi-language: | | <span class="ve-pasteProtect" style="mso-ansi-language: |
| DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref name=":0" /><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span> | | DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref name=":0" /><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span> |
| {| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | | |
| | |
| | {| class="wikitable |
| |+ | | |+ |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Antibiotikum''' | | !Antibiotikum |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Tagesdosis (1x tgl.)''' | | !Tagesdosis (1xtgl.) |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Bemerkung''' | | !Bemerkung |
| |- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Gentamicin
| | |Gentamicin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |4-10mg
| | |4-10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:1" data-ve-attributes="{"style":"mso-yfti-irow:1"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Tobramycin</span> | | |Tobramycin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">5-10mg</span> | | |5-10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:2" data-ve-attributes="{"style":"mso-yfti-irow:2"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Amikacin
| | |Amikacin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">30mg</span> | | |30mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:3" data-ve-attributes="{"style":"mso-yfti-irow:3"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Colistin
| | |Colistin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">10mg</span> | | |10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:4" data-ve-attributes="{"style":"mso-yfti-irow:4"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Daptomycin
| | |Daptomycin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">5-10mg</span> | | |5-10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:5" data-ve-attributes="{"style":"mso-yfti-irow:5"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Vancomycin
| | |Vancomycin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">10-20mg</span> | | |10-20mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:6" data-ve-attributes="{"style":"mso-yfti-irow:6"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Tigecyclin
| | |Tigecyclin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">1-10mg</span> | | |1-10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |
| | | |
| |- style="mso-yfti-irow:7;mso-yfti-lastrow:yes" data-ve-attributes="{"style":"mso-yfti-irow:7;mso-yfti-lastrow:yes"}" | | |- |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Caspofungin
| | |Caspofungin |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">5-10mg</span> | | |5-10mg |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | | |
| |}<br /> | | |- |
| | |} |
| | |
|
| |
|
| ===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Kalkulierte Therapie</span>=== | | ===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Kalkulierte Therapie</span>=== |
Therapie
Die Fokussanierung steht im Vordergrund, infizierte Kathetersysteme sollten entfernt werden. Begleitend erfolgt eine antibiotische Therapie, die zunächst hauptsächlich auf gram-positive Kokken zielt, begleitend sind Enterobacterales und Pseudomonas spp. zu erfassen. Es sollte bei Erregernachweis eine Deeskalation nach Antibiogramm erfolgen. Die Therapiedauer beträgt i.d.R. 10-14 Tage.
Dosierungsempfehlungen antibiotischer Therapien
intravenöse Applikation [1][2]
| Antibiotikum
|
Tagesdosis (Beispiel)
|
Bemerkung
|
Anpassung
|
| Aztreonam
|
6-8g (3-4x 2g)
|
|
|
| Cefepim
|
6g (3x 2g)
|
CI, PI
|
|
| Cefotaxim
|
12g (6x 2g)
|
|
|
| Ceftazidim
|
6g (3x 2g)
|
CI, PI, TDM
|
|
| Ceftriaxon
|
4g (2x 2g)
|
|
|
| Ciprofloxacin
|
1200mg (3x 400mg)
|
|
|
| Flucloxacillin
|
12g (6x 2g)
|
TDM
|
|
| Fluconazol
|
800mg (1x tgl.)
|
|
|
| Fosfomycin
|
24g (3x 8g)
|
|
|
| Linezolid
|
1200mg (2x 600mg)
|
CI, TDM
|
|
| liposomales Amphotericin B
|
2-5 mg/kg (1x tgl.)
|
|
|
| Meropenem
|
6g (3x 2g)
|
CI, PI, TDM
|
|
| Posaconazol
|
800mg (2x 400mg)
|
TDM
|
|
| Rifampicin
|
600-1200mg (1-2x tgl.)
|
|
|
| Vancomycin
|
30-60 mg/kg (2-4x tgl.)
|
CI, TDM
|
|
| Voriconazol
|
8 mg/kg (2x tgl.)
|
TDM
|
|
Legende:
- CI: kontinuierliche Infusion (engl. continuous infusion)
- PI: prolongierte Infusion (engl. prolonged infusion)
- TDM: Therapeutisches Drug Monitoring (engl. therapeutic drug monitoring)
intrathekale Applikation [1][3]
| Antibiotikum
|
Tagesdosis (1xtgl.)
|
Bemerkung
|
| Gentamicin
|
4-10mg
|
|
| Tobramycin
|
5-10mg
|
|
| Amikacin
|
30mg
|
|
| Colistin
|
10mg
|
|
| Daptomycin
|
5-10mg
|
|
| Vancomycin
|
10-20mg
|
|
| Tigecyclin
|
1-10mg
|
|
| Caspofungin
|
5-10mg
|
|
Kalkulierte Therapie
[1][2]
Vancomycin PLUS Meropenem
Alternative Meropenem: Ceftazidim oder Cefepim (im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)
Alternative Vancomycin: Linezolid (cave: bakteriostatisch)
Erregerspezifische Therapie
[1][2]
| Erreger
|
Standardtherapie
|
Alternativtherapie
|
| Enterobacterales (z.B. Klebsiella spp., E. coli)
|
Cefotaxim/Ceftriaxon
|
Cefepim, Meropenem, Ciprofloxacin
|
| Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. Enterobacter cloacae) oder ESBL-Bildner
|
Meropenem
|
Ciprofloxacin
|
| Pseudomonas aeruginosa
|
Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit FosfomycinColistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)
|
Aztreonam oder Ciprofloxacin
|
| Acinetobacter baumanii
|
Meropenem
|
Colistin (i.v.+i.t.)
|
| Staphylococcus spp. (Methicillin-empfindlich)
|
Flucloxacillinggf. PLUS Fosfomycin, Rifampicin oder Linezolid
|
Vancomycin
|
| Staphylococcus spp. (Methicillin-resistent)
|
Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid
|
Linezolid
|
| Candida spp.
|
liposomales Amphotericin B ggf. PLUS Flucytosin
|
Voriconazol, bei C. albicans: Fluconazol
|
| Aspergillus spp.
|
Voriconazol
|
liposomales Amphotericin B, Posaconazol
|
Legende: i.v. = intravenös, i.t. = intrathekal
Bei carbapenemresistenten gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden [33[4]. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.
- ↑ 1.0 1.1 1.2 1.3 28. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65
- ↑ 2.0 2.1 2.2 31. Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [https://www.awmf.org/leitlinien/detail/ll/030-089.html
- ↑ 32. Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)
- ↑ 33. Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650
