DGI:Endokarditis/Therapie: Difference between revisions

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(Der Seiteninhalt wurde durch einen anderen Text ersetzt: „<br /> ===Allgemeine Therapieprinzipien=== '''Endokarditis Board''' *Vorstellung aller Patient:innen mit Verdacht oder Nachweis e…“)
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**Bakteriämie mit koagulase-negativen Staphylokokken oder Cutibacterium (ehemals Propionibacterium) acnes ohne alternative Quelle und Verdacht auf eine Device Infektion
**Bakteriämie mit koagulase-negativen Staphylokokken oder Cutibacterium (ehemals Propionibacterium) acnes ohne alternative Quelle und Verdacht auf eine Device Infektion
**Bakteriämie durch andere Erreger ohne alternative Quelle
**Bakteriämie durch andere Erreger ohne alternative Quelle
===Antimikrobielle Therapie===
====a) Empirische Therapie====
()
mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:
0cm none black;mso-border-insidev:0cm none black"
mso-row-margin-right:36.0pt"
{| class="MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;" cellspacing="0" cellpadding="0" border="1"
| colspan="3" style="width:239.25pt;border:solid black 1.0pt;mso-border-alt:solid black .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="3" style="width:226.65pt;border:solid black 1.0pt;border-left:none;mso-border-left-alt:solid black .5pt;mso-border-alt:solid black .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |<span style="color: black">Alternative  bei Allergie</span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="3" style="width:239.25pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .5pt;mso-border-alt:solid black .5pt;mso-border-bottom-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="color: black">Nativklappe</span>'''
| colspan="3" style="width:226.65pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .5pt;mso-border-left-alt:solid black .5pt;mso-border-alt:solid black .5pt;mso-border-bottom-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:2;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Ampicillin  </span>
''<span style="color: black">plus</span>''
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">6x  2 g/d i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="color: black">4-6  w</span>
| style="width:68.3pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid black .5pt;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |<span style="color: black">Vancomycin<sup>3</sup></span>
''<span style="color: black">plus</span>''
| style="width:122.35pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="color: black">30  (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|- style="mso-yfti-irow:3;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Flucloxacillin</span>
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">6x2g  i.v. </span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |
| style="width:68.3pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid black .5pt;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |<span style="color: black">Gentamicin<sup>3</sup></span>
| style="width:122.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="color: black">1x  tgl. 3mg/kgKG i.v.</span>
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|- style="mso-yfti-irow:4;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |''<span style="color: black">plus</span>''
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |
| style="width:68.3pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid black .5pt;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |
| style="width:122.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|- style="mso-yfti-irow:5;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:solid .5pt;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:none 0cm;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Gentamicin<sup>3</sup></span>
| style="width:122.7pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">1x  tgl. 3mg/kgKG i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:none 0cm;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:solid .5pt;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |
| style="width:68.3pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:solid .5pt;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:none 0cm;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |
| style="width:122.35pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:none 0cm;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:solid .5pt;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |
| style="mso-cell-special:placeholder;border:none;border-bottom:solid black 1.0pt;" width="48" |
|- style="mso-yfti-irow:6;page-break-inside:avoid"
| colspan="6" style="width:465.9pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .5pt;mso-border-alt:solid black .5pt;mso-border-bottom-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''<span style="color: black">PVE<sup>5</sup> oder nosokomial</span>'''
|- style="mso-yfti-irow:7;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Vancomycin<sup>3</sup></span>
''<span style="color: black">plus</span>''
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">30  (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| style="width:41.6pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="color: black">6  w</span>
| rowspan="2" style="width:68.3pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |
| rowspan="2" style="width:122.35pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|- style="mso-yfti-irow:8;page-break-inside:avoid;mso-row-margin-right:36.0pt"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Gentamicin<sup>3</sup></span>
''<span style="color: black">plus</span>''
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |1x tgl. 3 mg/kgKG i.v.
| style="width:41.6pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|- style="mso-yfti-irow:9;mso-yfti-lastrow:yes;page-break-inside:avoid;"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:solid .5pt;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:none 0cm;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Rifampicin</span>
| style="width:122.7pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">2x  450 mg p.o. (ggf. i.v. bei Resorptionsstörung)</span>
| colspan="2" style="width:109.9pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="147" valign="top" |
| style="width:122.35pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:none 0cm;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:solid .5pt;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |
| style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm;" width="48" |
|}
====b) Spezifische Therapie====
======i) Staphylokokken======
mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:
none;mso-border-insidev:none"
{| class="MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt;" cellspacing="0" cellpadding="0" border="1"
| colspan="4" style="width:237.95pt;border:solid windowtext 1.0pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="317" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="3" style="width:227.95pt;border:solid windowtext 1.0pt;border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" valign="top" |<span style="color: black">Alternative  bei Allergie</span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="7" style="width:465.9pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''Methicillin-sensible ''S.  aureus'' (MSSA), Methicillin sensible Koagulase negative Staphylokokken'''
|- style="mso-yfti-irow:2;page-break-inside:avoid"
| colspan="4" style="width:237.95pt;border:solid windowtext 1.0pt;border-bottom:none black 1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="317" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">Nativklappe</span>'''
| colspan="3" style="width:227.95pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" valign="top" |
|- style="mso-yfti-irow:3;page-break-inside:avoid"
| style="width:74.1pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="99" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Flucloxacillin</span>
| style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6x2g i.v.</span>
| colspan="2" style="width:41.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4-6 w<sup>2</sup></span>
| style="width:68.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Cefazolin</span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">oder</span>''
<span style="font-family:&quot;Calibri&quot;,sans-serif">Vancomycin<sup>3</sup></span>
<span style="font-size:8.0pt;
  mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">Alternativ:</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">Daptomycin<sup>4</sup></span>
| style="width:123.6pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="165" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">3x 2g i.v.</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">30(-60)  mg/kg KG in 2 ED</span>
<span style="font-size:11.0pt;
  font-family:&quot;Calibri&quot;,sans-serif">1x 10-12mg/kgKG/d</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4-6 w</span>
|- style="mso-yfti-irow:4;page-break-inside:avoid"
| colspan="4" style="width:237.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="317" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">PVE<sup>5</sup></span>'''
| colspan="3" style="width:227.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" valign="top" |
|- style="mso-yfti-irow:5;page-break-inside:avoid"
| style="width:74.1pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="99" valign="top" |Flucloxacillin
''plus''
Rifampicin
''plus''
Gentamicin<sup>3</sup>
| style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6x2g i.v.</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">2x  450 mg p.o. (ggf. i.v. bei Resorptionsstörung)</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">1x  tgl. 3mg/kgKG i.v.</span>
| colspan="2" style="width:41.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">6  w</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">2  w</span>
| style="width:68.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Cefazolin</span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">oder</span>''
<span style="font-family:&quot;Calibri&quot;,sans-serif">Vancomycin<sup>3</sup></span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">jeweils  plus</span>''
<span style="font-family:&quot;Calibri&quot;,sans-serif">Rifampicin</span>
''<span style="font-size:
  8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">plus</span>''
Gentamicin<sup>3</sup>
| style="width:123.6pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="165" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">3x 2g i.v.</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">30  (-60) mg/kg KG in 2 ED</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">2x  450 mg p.o. (ggf. i.v. bei Resorptionsstörung)</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">1x  tgl. 3mg/kgKG i.v.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |6  w
6 w
2 w
|- style="mso-yfti-irow:6;page-break-inside:avoid"
| colspan="7" style="width:465.9pt;border:solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''Methicillin-resistente ''S.  aureus'' (MRSA),<span style="mso-spacerun:yes">  </span>Methicillin resistente  Koagulase negative Staphylokokken'''
|- style="mso-yfti-irow:7;page-break-inside:avoid"
| colspan="3" style="width:237.65pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="317" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">Nativklappe</span>'''
| colspan="4" style="width:228.25pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" valign="top" |
|- style="mso-yfti-irow:8;page-break-inside:avoid"
| style="width:74.1pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="99" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Vancomycin<sup>3</sup></span>
| style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">30 (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| colspan="2" style="width:41.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
| style="width:68.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |Alternativ:
| style="width:123.6pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="165" valign="top" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |
|- style="mso-yfti-irow:9;page-break-inside:avoid"
| style="width:74.1pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="99" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">PVE<sup>5</sup></span>'''
| style="width:122.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |
| colspan="2" style="width:41.5pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |
| style="width:68.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |Daptomycin<sup>4</sup>
| style="width:123.6pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="165" valign="top" |<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif">10-12mg/kgKG 1x  tgl.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |6  w
|- style="mso-yfti-irow:10;mso-yfti-lastrow:yes;page-break-inside:avoid"
| style="width:74.1pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="99" valign="top" |Vancomycin<sup>3</sup>
''plus''
Rifampicin
''plus''
Gentamicin<sup>3</sup>
| style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">30 (-60) mg/kg KG in 2 ED<sup>3</sup>  i.v. oder Perfusor<sup>1</sup></span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">2x  450 mg p.o. (ggf. i.v. bei Resorptionsstörung)</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">1x  tgl. 3mg/kgKG i.v.</span>
| colspan="2" style="width:41.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">6w</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">2  w</span>
| style="width:68.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="91" valign="top" |
| style="width:123.6pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="165" valign="top" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |
|}
======ii) Enterokokken und Penicillin-resistente Streptokokken======
mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:
none;mso-border-insidev:none"
{| class="MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt;" cellspacing="0" cellpadding="0" border="1"
| colspan="3" style="width:239.25pt;border:solid windowtext 1.0pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="3" style="width:227.7pt;border:solid windowtext 1.0pt;border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" |<span style="color: black">Alternative  bei Allergie</span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="6" style="width:466.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="623" |'''<span style="color: black">Beta-Lactam  sensibel, Gentamicin sensibel<sup>6</sup></span>'''
|- style="mso-yfti-irow:2;page-break-inside:avoid"
| colspan="3" style="width:239.25pt;border:solid windowtext 1.0pt;border-bottom:none black 1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">Nativklappe</span>'''
| colspan="3" style="width:227.7pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="304" |
|- style="mso-yfti-irow:3;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Ampicillin</span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">plus</span>''
| style="width:122.7pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4x 4g/d i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4-6 w</span>
| style="width:69.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="92" |<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif">Vancomycin<sup>3</sup></span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">plus</span>''
| style="width:122.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" |<span style="font-family:&quot;Calibri&quot;,sans-serif">30 (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
|- style="mso-yfti-irow:4;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Gentamicin<sup>3</sup></span>
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1x tgl. 3mg/kg KG i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" |<span style="font-family:&quot;Calibri&quot;,sans-serif">2-6 w</span>
| style="width:69.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="92" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Gentamicin<sup>3</sup></span>
| style="width:122.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1x tgl. 3mg/kg KG i.v.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
|- style="mso-yfti-irow:5;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" |<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">bei ''E. faecalis'' mit Gentamicin<span style="mso-spacerun:yes">  </span>High Level Resistenz (HLR)</span>
| style="width:122.7pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" |
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" |
| style="width:69.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="92" |
| style="width:122.35pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" |
|- style="mso-yfti-irow:6;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Ampicillin</span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">plus</span>''
| style="width:122.7pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4x 4g/d i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
| rowspan="2" style="width:69.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="92" |
| rowspan="2" style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" |
| rowspan="2" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" |
|- style="mso-yfti-irow:7;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Ceftriaxon</span>
| style="width:122.7pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" |<span style="font-family:&quot;Calibri&quot;,sans-serif">2x2g i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
|- style="mso-yfti-irow:8;page-break-inside:avoid"
| colspan="4" style="width:308.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="411" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">PVE<sup>5</sup>:<span style="mso-spacerun:yes">  </span></span>'''<span style="font-family:&quot;Calibri&quot;,sans-serif">s.  Nativklappe, aber Therapiedauer 6 w</span>
| style="width:122.35pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="163" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" |
|- style="mso-yfti-irow:9;page-break-inside:avoid"
| colspan="6" style="width:466.95pt;border:solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="623" |'''Beta-Lactam resistent<sup>7</sup>'''
|- style="height:34.9ptpx;"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="100" |<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif">Vancomycin<sup>3</sup></span>
''<span style="font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:&quot;Calibri&quot;,sans-serif">plus</span>''
<span style="font-family:&quot;Calibri&quot;,sans-serif">Gentamicin<sup>3</sup></span>
| style="width:122.7pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="164" |<span style="font-family:&quot;Calibri&quot;,sans-serif">30 (-60) mg/kg KG in 2 ED<sup>3</sup></span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">1x  tgl. 3mg/kg KG i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="55" |<span style="font-family:&quot;Calibri&quot;,sans-serif">6 w</span>
<span style="font-family:&quot;Calibri&quot;,sans-serif">6  w</span>
| style="width:69.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="92" |<span style="font-family:&quot;Calibri&quot;,sans-serif">s.o.</span>
| style="width:122.35pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="163" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;height:34.9pt;" width="48" |
|}
======iii) Streptokokken (orale Streptokokken, ''S. bovis'')======
mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:1184;mso-padding-alt:
0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:none;mso-border-insidev:none"
{| class="MsoTableGrid" style="border-collapse:collapse;mso-table-layout-alt:fixed;border:none;" cellspacing="0" cellpadding="0" border="1"
| colspan="3" style="width:239.5pt;border:solid windowtext 1.0pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="4" style="width:226.4pt;border:solid windowtext 1.0pt;border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |<span style="color: black">Alternative  bei Penicillinallergie</span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="4" style="width:239.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="320" valign="top" |'''<span style="color: black">Penicillin-empfindliche Stämme (MHK ≤  0.125mg/L)</span>'''
| colspan="3" style="width:226.1pt;border:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="301" valign="top" |
|- style="mso-yfti-irow:2;page-break-inside:avoid"
| colspan="3" style="width:239.5pt;border:solid windowtext 1.0pt;border-bottom:none black 1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="color: black">Nativklappe</span>'''
| colspan="4" style="width:226.4pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:3;page-break-inside:avoid"
| style="width:74.7pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Penicillin  G</span>
''<span style="color: black">oder</span>''
| style="width:128.55pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="171" valign="top" |<span style="color: black">6x  4 Mio IE i.v. </span>
| style="width:36.25pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
| colspan="2" style="width:69.45pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="93" valign="top" |<span style="color: black">Vancomycin<sup>3</sup></span>
| style="width:120.95pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="161" valign="top" |<span style="color: black">30  (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
|- style="mso-yfti-irow:4;page-break-inside:avoid"
| style="width:74.7pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Ceftriaxon</span>
| style="width:128.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="171" valign="top" |<span style="color: black">1x2g/d</span>
| style="width:36.25pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
| colspan="2" style="width:69.45pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="93" valign="top" |
| style="width:120.95pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="161" valign="top" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |
|- style="mso-yfti-irow:5;page-break-inside:avoid"
| colspan="7" style="width:465.9pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''<span style="color: black">PVE<sup>5</sup>:<span style="mso-spacerun:yes">  </span></span>'''<span style="color: black">s. Nativklappe, aber Therapiedauer 6w</span>
|- style="mso-yfti-irow:6;page-break-inside:avoid"
| colspan="7" style="width:465.9pt;border:solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''<span style="color: black">Penicillin- sensible Stämme bei  erhöhter Dosis (MHK 0.25-2mg/L)</span>'''
|- style="mso-yfti-irow:7;page-break-inside:avoid"
| colspan="3" style="width:239.5pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="color: black">Nativklappe</span>'''
| colspan="4" style="width:226.4pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:8;page-break-inside:avoid"
| style="width:74.7pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Penicillin  G</span>
''<span style="color: black">oder</span>''
| style="width:128.55pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="171" valign="top" |<span style="color: black">6x  4 Mio IE i.v. oder 24 Mio IE per Dauerinfusion </span>
| style="width:36.25pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
| colspan="2" style="width:69.45pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="93" valign="top" |<span style="color: black">Vancomycin<sup>3</sup></span>
''<span style="color: black">plus</span>''
| style="width:120.95pt;border:none;border-bottom:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="161" valign="top" |<span style="color: black">30  (-60) mg/kg KG in 2 ED<sup>3</sup></span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
|- style="mso-yfti-irow:9;page-break-inside:avoid"
| style="width:74.7pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Ceftriaxon</span>
''<span style="color: black">jeweils plus</span>''
| style="width:128.55pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="171" valign="top" |<span style="color: black">1x2g/d</span>
| style="width:36.25pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
| colspan="2" style="width:69.45pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="93" valign="top" |<span style="color: black">Gentamicin<sup>3</sup></span>
| style="width:120.95pt;border-bottom:black 1.0pt;border-right:black 1.0pt;border-style:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="161" valign="top" |<span style="color: black">1x  tgl. 3mg/kgKG i.v.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">2w</span>
|- style="mso-yfti-irow:10;page-break-inside:avoid"
| style="width:74.7pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Gentamicin<sup>3</sup></span>
| style="width:128.55pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="171" valign="top" |<span style="color: black">1x  tgl. 3mg/kgKG i.v.</span>
| style="width:36.25pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">2w</span>
| colspan="2" style="width:69.45pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="93" valign="top" |
| style="width:120.95pt;border:none;border-bottom:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="161" valign="top" |
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |
|- style="mso-yfti-irow:11;page-break-inside:avoid"
| colspan="3" style="width:239.5pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="color: black">PVE<sup>5</sup>:<span style="mso-spacerun:yes">  </span></span>'''<span style="color: black">s. Nativklappe, aber Therapiedauer 6 w</span>
| colspan="4" style="width:226.4pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;background:white;mso-background-themecolor:background1;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:12;mso-yfti-lastrow:yes;page-break-inside:avoid"
| colspan="7" style="width:465.9pt;border:solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''<span style="color: black">Penicillin-resistente Stämme (MHK  >2mg/L) : s. Enterokokken Endokarditis</span>'''
|}
======iv) HACEK-Gruppe<sup>8</sup>======
mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:
none;mso-border-insidev:none"
{| class="MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt;" cellspacing="0" cellpadding="0" border="1"
| colspan="3" style="width:239.25pt;border:solid windowtext 1.0pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="3" style="width:226.65pt;border:solid windowtext 1.0pt;border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |<span style="color: black">Alternative  (auch bei Allergie) </span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="3" style="width:239.25pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">Nativklappe</span>'''
| colspan="3" style="width:226.65pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;mso-border-bottom-alt:none black 0cm;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:2;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid black 1.0pt;border-right:none;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid black .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Ceftriaxon</span>
| style="width:122.7pt;border:none;border-bottom:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1x 2g i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4 w</span>
| style="width:71.85pt;border:none;border-bottom:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid black .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="96" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">Ciprofloxacin<sup>9</sup></span>
| style="width:118.8pt;border:none;border-bottom:solid black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="158" valign="top" |<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,sans-serif">2-3x 400mg i.v.  oder 2x 750mg p.o.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">4 w</span>
|- style="mso-yfti-irow:3;mso-yfti-lastrow:yes;page-break-inside:avoid"
| colspan="6" style="width:465.9pt;border:solid black 1.0pt;border-top:none;mso-border-top-alt:solid black .5pt;mso-border-alt:solid black .5pt;padding:0cm 5.65pt 1.4pt 5.65pt;" width="621" valign="top" |'''<span style="font-family:&quot;Calibri&quot;,sans-serif">PVE<sup>5</sup></span>''' <span style="font-family:&quot;Calibri&quot;,sans-serif">s. Nativklappe, aber Therapiedauer  6 w</span>
|}
======v) Cutibacterium sp.======
mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.65pt 1.4pt 5.65pt;mso-border-insideh:
0cm none black;mso-border-insidev:0cm none black"
{| class="MsoTableGrid" style="border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;" cellspacing="0" cellpadding="0" border="1"
| colspan="3" style="width:239.25pt;border:solid black 1.0pt;mso-border-alt:solid black .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |<span style="font-family:&quot;Calibri&quot;,sans-serif">1. Wahl</span>
| colspan="3" style="width:226.65pt;border:solid black 1.0pt;border-left:none;mso-border-left-alt:solid black .5pt;mso-border-alt:solid black .5pt;background:#F2DBDB;mso-background-themecolor:accent2;mso-background-themetint:51;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |<span style="color: black">Alternative  (auch bei Allergie) </span>
|- style="mso-yfti-irow:1;page-break-inside:avoid"
| colspan="3" style="width:239.25pt;border-top:none;border-left:solid black 1.0pt;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .5pt;mso-border-alt:solid black .5pt;mso-border-bottom-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="319" valign="top" |'''<span style="color: black">Nativklappe</span>'''
| colspan="3" style="width:226.65pt;border-top:none;border-left:none;border-bottom:none black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:solid black .5pt;mso-border-left-alt:solid black .5pt;mso-border-alt:solid black .5pt;mso-border-bottom-alt:none black 0cm;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="302" valign="top" |
|- style="mso-yfti-irow:2;mso-yfti-lastrow:yes;page-break-inside:avoid"
| style="width:74.95pt;border-top:none;border-left:solid black 1.0pt;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:solid .5pt;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:none 0cm;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="100" valign="top" |<span style="color: black">Penicillin  G</span>
| style="width:122.7pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="164" valign="top" |<span style="color: black">6x  4 Mio IE/d i.v.</span>
| style="width:41.6pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:none 0cm;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:solid .5pt;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="55" valign="top" |<span style="color: black">4  w</span>
| style="width:71.85pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:solid .5pt;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:none 0cm;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="96" valign="top" |<span style="color: black">Clindamycin</span>
| style="width:118.8pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:none black 1.0pt;mso-border-top-alt:none black 0cm;mso-border-left-alt:none black 0cm;mso-border-alt:none black 0cm;mso-border-bottom-alt:solid black .5pt;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="158" valign="top" |<span style="color: black">3x 600mg i.v./p.o.</span>
| style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;mso-border-top-alt:none 0cm;mso-border-left-alt:none 0cm;mso-border-bottom-alt:solid .5pt;mso-border-right-alt:solid .5pt;mso-border-color-alt:black;background:white;padding:0cm 5.65pt 1.4pt 5.65pt;" width="48" valign="top" |<span style="color: black">4  w</span>
|}
Eine durch andere, hier nicht im Einzelnen aufgeführte, Erreger ausgelöste Endokarditis ist selten. Festlegung der Therapie durch ABS- oder infektiologisches Konsil bzw. Diskussion im Endokarditis-Board.
<small>1 4g ad 50ml Aqua, Laufrate 6,25 ml/h</small>
<small>2 Bei isolierter rechtsseitiger Nativklappen-Endokarditis kann eine Therapie mit Flucloxacillin für 2 Wochen ausreichend sein</small>
<small>3 ab 3. Behandlungstag Dosierung nach Talspiegel modifizieren. Zieltalspiegel Vanco 15-20mg/l, Gentamicin: Talspiegel <1mg/l, Spitzenspiegel 1h nach Gabe 10-12mg/l</small>
<small>4 nicht mit Simvastatin verabreichen und wöchentliche CK messen. Um einer Resistenzbildung vorzubeugen, sollte eine Kombinationstherapie erwogen werden nach Maßgabe des ABS Teams / Endokarditis Boards.</small>
<small>5 PVE = prosthetic valve endocarditis, <12 Monate nach Herzklappenersatz, oder Klappen- bzw. Vitiumrekonstruktion</small>
<small>6 bei High-level Gentamicin Resistenz: Ampicillin + Ceftriaxon Regime, alternativ bei Streptomycin-Empfindlichkeit: Streptomycin 15mg/kg KG in 2 ED anstatt Genta</small>
<small>7 bei komplizierten Resistenzen (Ampicillin, Gentamicin, Vancomycin) alternativ Daptomycin, Therapiefestlegung durch EK Board</small>
<small>8bei Organismen der HACEK-Gruppe besteht i.d.R. Empfindlichkeit gegenüber Cephalosporinen der 3. Generation; Antibiogramm beachten</small>
<small>9Therapie mit Fluorchinolonen aufgrund möglicher erheblicher Nebenwirkungen (Tendinitis, Aortitis, schwere psychische und neurologische NW) nur bei fehlenden Therapiealternativen und nach Rücksprache Infektiologie / ABS Team / Mikrobiologie /  Endokarditis Board</small>
====c) POET-Studie: Möglichkeiten der oralen Sequenztherapie====
Die Ergebnisse der im Januar 2019 im NEJM veröffentlichten randomisiert-kontrollierten POET-Studie stellen erstmals das Dogma der ausschließlich intravenösen antibiotischen Therapie für Patienten mit Linksherzendokarditis in Frage. Den Ergebnissen nach scheint <u>für eine sorgfältig ausgewählte</u> <u>Patientengruppe</u> (kleine Vegetationen, rasches und gutes klinisches Ansprechen nach zehntägiger i.v.-antibiotischer Therapie (Median iR der Studie 17 d!) und Fehlen paravalvulärer Komplikationen) eine orale Sequenztherapie (mit zwei Antibiotika mit hoher Bioverfügbarkeit, frühestens 7d nach operativen Klappenersatz) zu ähnlichen Therapieergebnissen wie eine durchgehende i.v.-antibiotische Therapie zu führen.
Vor einer leichtfertigen Oralisierung der Therapie muss jedoch weiterhin ausdrücklich gewarnt werden - insbesondere beim Vorliegen einer Prothesenklappenendokarditis und schwer zu behandelnder Erreger wie Staphylokokken und Enterokokken. Eine vorherige infektiologische Beratung und engmaschige klinische Kontrollen werden dringend empfohlen.




Revision as of 19:42, 17 March 2022


Allgemeine Therapieprinzipien

Endokarditis Board

  • Vorstellung aller Patient:innen mit Verdacht oder Nachweis einer IE in einem Endokarditis Board (s.u.).


Antimikrobielle Therapie

  • ≥ 3 Blutkulturpärchen abnehmen vor Einleitung der antimikrobiellen Therapie
  • Einleitung einer empirischen Therapie (siehe unten) bei akut erkrankten Patient:innen mit eindeutigen klinischen Hinweisen nach Entnahme der Blutkulturen
  • Kontroll-Blutkulturen bis zum Nachweis der Clearance (Verweis zu S. aureus - Blutstrominfektionen)
  • Anpassung der antimikrobiellen Therapie an das Antibiogramm, sobald verfügbar, nach Empfehlung des Endokarditis Boards
  • Die Kunstklappenendokarditis (PVE) mit Klappenersatz vor ≥ 12 Monate (biologisch oder künstlich) wird wie eine Nativklappenendokarditis behandelt


Therapiedauer in der Regel (4-) 6 Wochen.

  • Bei positiver BK berechnet ab Abnahmedatum der ersten negativen BK
  • Bei kulturellem Erregernachweis von der Klappe/intraop. Material wird die Dauer ab OP berechnet
  • Bei steriler Klappe/intraop. Material ab der ersten negativen BK


Mangement:

  • Verlaufs-TEE: Immer bei V.a. Komplikation (neues Herzgeräusch, persistierendes Fieber, kardialer Dekompensation, AV-Block, Abszess), andernfalls nach Maßgabe des Endokarditis Boards, ggf. Kontaktaufnahme mit einem solchen
  • Antikoagulation: Trotz erhöhtem Risiko für kardioembolische Ereignisse keine generelle Indikation
  • Zahnpflege / Zahnextraktion: Bei IE durch Bakterien der Oropharyngealflora Zahnstatus auf mögliche Eintrittspforten evaluieren und entsprechend therapieren
  • Koloskopie: Bei Patient:innen mit Nachweis von Streptococcus gallolyticus (früher: S. bovis) besteht eine hohe Assoziation mit Kolon-Karzinom, daher sollte möglichst immer eine Koloskopie erfolgen
  • Intravaskuläre Katheter sollen bei Endokarditis entfernt werden
  • Herzschrittmacher / ICD u.a.: Entfernung aller implantierten kardialen Fremdkörper bei:
    • Nachweis einer Device / Tascheninfektion (Vegetation an Kabeln, Klappe, Rötung, Schmerz, Eiteraustritt an Tasche, auch ohne positive Blutkulturen!)
    • Nachweis von S. aureus oder Candida spp. in Blutkulturen (auch ohne Hinweis auf Device / Tascheninfektion!)
    • Bakteriämie mit koagulase-negativen Staphylokokken oder Cutibacterium (ehemals Propionibacterium) acnes ohne alternative Quelle und Verdacht auf eine Device Infektion
    • Bakteriämie durch andere Erreger ohne alternative Quelle


Frühe chirurgische Therapie

Eine frühe chirurgische Therapie (definiert als chirurgische Therapie vor Abschluss der antiinfektiven Therapie) kann bei verschiedenen Faktoren zur Reduktion der Mortalität erforderlich sein:

  • Bei Linksherzendokarditis:
    •  Klinischen Zeichen der Klappendysfunktion (in der Regel Aorten- oder Mitralinsuffizienz)
    •  Paravalvuläre Ausbreitung der Infektion mit anulärem oder aortalem Abszess, penetrierende Läsion (Fistel) oder Herzrhythmusstörungen (in der Regel AV-Block)
    •  Durch alleinige antiinfektive Therapie nicht sanierbarer Infektionsherd
    •  Unter antiinfektiver Therapie >7 Tage persistierende Bakteriämie oder Fieber und Ausschluss eines weiteren Fokus
    •  Vegetationen >10 mm, hier soll interdisziplinär ein individueller Therapiekonsens diskutiert werden (siehe unten, Endokarditis-Board)


  • Bei Rechtsherzendokarditis:
    •  Vegetationen >20 mm
    •  Wiederholte pulmonale septische Embolien
    •  Durch alleinige antiinfektive Therapie nicht sanierbarer Infektionsherd (z.B. bei mykotischer IE)
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