DGI:ZNS-Infektionen/Tuberkulose Meningitis/Therapie: Difference between revisions

From Infektiopedia
imported>Brinkery
No edit summary
imported>Brinkery
No edit summary
Line 1: Line 1:
==Therapie==
==Therapie==
{| class="wikitable |+
{| class="wikitable  
! style="width:78pt;" class="col-grey-light-bg" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">'''Klinische <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Situation</span>'''</span>
|+
! style="width:63.75pt;" class="col-grey-light-bg" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Präferenz'''</span>
!Klinische Situation
! style="width:78pt;" class="col-grey-light-bg" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Substanz'''</span>
!Präferenz
! style="width:70.85pt;" class="col-grey-light-bg" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dosierung'''</span>
!Substanz
! style="width:2cm;" class="col-grey-light-bg" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Dauer'''</span>
!Dosierung
! style="width:2cm;" class="col-grey-light-bg" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Anpas-sungen'''</span>
!Dauer
! style="width:49.35pt;" class="col-grey-light-bg" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">'''Liquor- Gängig-keit'''</span>
!Liquor Gängigkeit
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|-
| rowspan="3" style="" data-ve-attributes="{&quot;style&quot;:&quot;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Tuberkulöse Meningitis</span>
| rowspan="3" Tuberkulöse Meningitis
| rowspan="2" style="" data-ve-attributes="{&quot;style&quot;:&quot;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Therapie der Wahl</span>
| rowspan="2" Therapie der Wahl
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Rifampicin</span>
| Rifampicin
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">10 mg/kg KG, max 600 mg</span>
| 10 mg/kg KG, max 600 mg
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">12 Monate</span>
| 12 Monate
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
| 10-20%
| style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">10-20%</span>
|-
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
|-  
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Isoniazid</span>
|
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Pyrazinamid</span>
*Isoniazid
 
*Pyrazinamid
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ethambutol</span>
*Ethambutol
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">5 mg/kg KG</span>
|*5 mg/kg KG
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">25 mg/kg KG</span>
*25 mg/kg KG
 
*15 mg/kg KG
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">15 mg/kg KG</span>
|  
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">12 Monate</span>
*12 Monate
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ersten</span>
*Ersten  
 
2 Monate
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">2 Monate</span>
*Ersten  
 
2 Monate
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Ersten</span>
|  
 
*80-90%
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">2 Monate</span>
*90-100%
| style="width:2cm;" width="76" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:2cm;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">-</span>
*20-30
| style="width:49.35pt;" width="66" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:49.35pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">80-90%</span>
|-
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">90-100%</span>
|-  
 
| style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtec t"style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Zusatz</span>
<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">20-30%</span>
|- style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}"
| style="width:63.75pt;" width="85" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:63.75pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Zusatz</span>
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Vitamin B6 <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[9]</span></span>
| style="width:78pt;" width="104" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:78pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">Vitamin B6 <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}">[9]</span></span>
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">40 mg/d</span>
| style="width:70.85pt;" width="94" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:70.85pt;&quot;}" |<span class="ve-pasteProtect" style="box-sizing: inherit; font-family: Arial, sans-serif;" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}">40 mg/d</span>

Revision as of 09:08, 17 June 2021

Therapie

Klinische Situation Präferenz Substanz Dosierung Dauer Liquor Gängigkeit
rowspan="3" Tuberkulöse Meningitis rowspan="2" 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[1], 2[2], 5[3], 7[4]] 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[5], 11[6]].

MDR = multi-drug resistance, RMP = Rifampicin

  1. ↑ Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 2;302(21):2323-9
  2. ↑ Kumta N, Roberts JA, Lipman J et al. Antibiotic distribution into cerebrospinal fluid: Can dosing safely account for drug and disease factors in the treatment of ventriculostomy-associated infections? Clin Pharmacokinet 2018; 57: 439–454
  3. ↑ Nau R et al. S1-Leitlinie Hirnabszess. 2016. In: Deutsche Gesellschaft für Neurologie, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien
  4. ↑ Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen - Update 2018. https://www.awmf.org/leitlinien/detail/ll/082-006.html
  5. ↑ Ducomble T, et al., The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill, 2013; 18(12)
  6. ↑ in Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. 2011; London
Retrieved from "https://wiki.cakele.iodatalabs.dev/index.php?title=DGI:ZNS-Infektionen/Tuberkulose_Meningitis/Therapie&oldid=2333"