DGI:ZNS-Infektionen/Tuberkulose Meningitis/Therapie: Difference between revisions
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==Therapie== | ==Therapie== | ||
{| class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: "Open Sans", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{"style":"box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \"Open Sans\", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;"}" | {| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: "Open Sans", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{"style":"box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \"Open Sans\", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;"}" | ||
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" | | |+ | ||
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-family: Arial, sans-serif;"}">'''Klinische <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Situation</span>'''</span> | |||
! class="col-grey-light-bg" style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{"style":"width:63.75pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Präferenz'''</span> | |||
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Substanz'''</span> | |||
! class="col-grey-light-bg" style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{"style":"width:70.85pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Dosierung'''</span> | |||
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{"style":"width:2cm;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Dauer'''</span> | |||
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{"style":"width:2cm;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Anpas-sungen'''</span> | |||
! class="col-grey-light-bg" style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{"style":"width:49.35pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Liquor- Gängig-keit'''</span> | |||
|- style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}" | |- style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}" | ||
| rowspan="3" style="" data-ve-attributes="{"style":""}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-family: Arial, sans-serif;"}">Tuberkulöse Meningitis</span> | | rowspan="3" style="" data-ve-attributes="{"style":""}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-family: Arial, sans-serif;"}">Tuberkulöse Meningitis</span> | ||
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|} | |} | ||
Tabelle 2: First line Medikamente zur Behandlung der Tbc | Tabelle 2: First line Medikamente zur Behandlung der Tbc | ||
{| class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: "Open Sans", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{"style":"box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \"Open Sans\", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;"}" | {| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="604" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: "Open Sans", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;" data-ve-attributes="{"style":"box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \"Open Sans\", Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-left: -0.25pt;"}" | ||
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" | | |+ | ||
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;"}">'''Klinische Situation'''</span> | |||
! class="col-grey-light-bg" style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{"style":"width:63.75pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Präferenz'''</span> | |||
! class="col-grey-light-bg" style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Substanz'''</span> | |||
! class="col-grey-light-bg" style="width:77.95pt;" width="104" valign="top" data-ve-attributes="{"style":"width:77.95pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Dosierung'''</span> | |||
! class="col-grey-light-bg" style="width:2cm;" width="76" valign="top" data-ve-attributes="{"style":"width:2cm;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Dauer'''</span> | |||
! class="col-grey-light-bg" style="width:49.6pt;" width="66" valign="top" data-ve-attributes="{"style":"width:49.6pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Anpas-sungen'''</span> | |||
! colspan="2" class="col-grey-light-bg" style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{"style":"width:49.35pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Liquor Gängig-keit'''</span> | |||
|- style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}" | |- style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}" | ||
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;"}">Tuberkulöse Meningitis</span> | | style="width:78pt;" width="104" valign="top" data-ve-attributes="{"style":"width:78pt;"}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;" data-ve-attributes="{"style":"box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;"}">Tuberkulöse Meningitis</span> | ||
Revision as of 13:36, 15 December 2020
Therapie
| Klinische Situation | Präferenz | Substanz | Dosierung | Dauer | Anpas-sungen | Liquor- Gängig-keit |
|---|---|---|---|---|---|---|
| Tuberkulöse Meningitis | Therapie der Wahl | Rifampicin | 10 mg/kg KG, max 600 mg | 12 Monate | - | 10-20% |
| Isoniazid
Pyrazinamid Ethambutol |
5 mg/kg KG
25 mg/kg KG 15 mg/kg KG |
12 Monate
Ersten 2 Monate Ersten 2 Monate |
- | 80-90%
90-100% 20-30% | ||
| Zusatz | Vitamin B6 [9] | 40 mg/d | mit INH | - | - |
Tabelle 2: First line Medikamente zur Behandlung der Tbc
| Klinische Situation | Präferenz | Substanz | Dosierung | Dauer | Anpas-sungen | Liquor Gängig-keit | |
|---|---|---|---|---|---|---|---|
| Tuberkulöse Meningitis | Second line | Levofloxacin
Moxifloxacin Amikacin Kanamycin Capreomycin Ethionamid Cycloserin Linezolid |
10-15 mg/kg
400mg 15 mg/kg, max 1g i.v. 15 mg/kg, max 1g i.v. 15 mg/kg, max 1g i.v. 15-20 mg/kg, max 1g i.v. 10-20 mg/kg, max 1g i.v. 600 mg |
durch-gängig
Intensiv- phase |
70-80%
70-80% 10-20% 10-20% 80-90% 80-90% 30-70% |
||
Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc
Zusätzlich zur antituberkulösen Chemotherapie [1, 2, 5, 7] sollte Dexamethason oder Prednisolon verabreicht werden. Für Deutschland wird in Übereinstimmung mit den NICE-Empfehlungen beim Erwachsenen (> 15 Jahre) eine Prednisolon-Dosis von 40 mg/Tag (ohne RMP-Gabe: 20 mg/Tag) empfohlen, welche nach 2-3 Wochen um jeweils 10 mg/Woche reduziert und dann beendet werden kann [10, 11].
MDR = multi-drug resistance, RMP = Rifampicin