DGI:ZNS-Infektionen/Tuberkulose Meningitis/Therapie: Difference between revisions
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|+<span id="Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc">Tabelle 3: Core second-line Medikamente zur Therapie der MDR-Tbc</span> | |||
!Patienteneigene<br /> | |||
!Klinische Situation | |||
!Präferenz | |||
!Substanz | |||
!Dosierung | |||
!Dauer | |||
| | !Liquor Gängigkeit | ||
< | |- | ||
|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 | |||
| | |||
*durchgängig | |||
*durchgängig | |||
70-80% | *Intensivphase | ||
*Intensivphase | |||
10-20% | *Intensivphase | ||
*durchgängig | |||
10-20% | *durchgängig | ||
*durchgängig | |||
80-90% | | | ||
*70-80% | |||
80-90% | *70-80% | ||
*10-20% | |||
30-70% | *10-20% | ||
*80-90% | |||
*80-90% | |||
*30-70% | |||
|} | |} | ||
<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;"}">Zusätzlich zur antituberkulösen Chemotherapie <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">[1</span></span><ref><span style="color: rgb(51, 51, 51)">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</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 2</span></span><ref><span style="color: rgb(51, 51, 51)">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</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 5</span></span><ref><span style="color: rgb(51, 51, 51)">Nau R et al. S1-Leitlinie Hirnabszess. 2016. In: Deutsche Gesellschaft für Neurologie, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Online:</span> [http://www.dgn.org/leitlinien www.dgn.org/leitlinien]<br /></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 7</span></span><ref><span style="color: rgb(51, 51, 51)">Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen - Update 2018. <nowiki>https://www.awmf.org/leitlinien/detail/ll/082-006.html</nowiki></span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">]</span></span> <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;"}">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 <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">[10</span></span><ref><span style="color: rgb(51, 51, 51)">Ducomble T, et al., The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill, 2013;</span> '''18'''<span style="color: rgb(51, 51, 51)">(12)</span><br /></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 11</span></span><ref><span style="color: rgb(51, 51, 51)">in Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. 2011; London</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">]</span>.</span> | <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;"}">Zusätzlich zur antituberkulösen Chemotherapie <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">[1</span></span><ref><span style="color: rgb(51, 51, 51)">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</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 2</span></span><ref><span style="color: rgb(51, 51, 51)">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</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 5</span></span><ref><span style="color: rgb(51, 51, 51)">Nau R et al. S1-Leitlinie Hirnabszess. 2016. In: Deutsche Gesellschaft für Neurologie, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Online:</span> [http://www.dgn.org/leitlinien www.dgn.org/leitlinien]<br /></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 7</span></span><ref><span style="color: rgb(51, 51, 51)">Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen - Update 2018. <nowiki>https://www.awmf.org/leitlinien/detail/ll/082-006.html</nowiki></span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">]</span></span> <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;"}">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 <span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">[10</span></span><ref><span style="color: rgb(51, 51, 51)">Ducomble T, et al., The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill, 2013;</span> '''18'''<span style="color: rgb(51, 51, 51)">(12)</span><br /></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">, 11</span></span><ref><span style="color: rgb(51, 51, 51)">in Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. 2011; London</span></ref><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;"}"><span class="ve-pasteProtect" style="box-sizing: inherit;" data-ve-attributes="{"style":"box-sizing: inherit;"}">]</span>.</span> | ||
MDR = multi-drug resistance, RMP = Rifampicin | MDR = multi-drug resistance, RMP = Rifampicin | ||
Revision as of 09:24, 17 June 2021
Therapie
| Patienteneigene |
Klinische Situation | Präferenz | Substanz | Dosierung | Dauer | Liquor Gängigkeit |
|---|---|---|---|---|---|---|
| Tuberkulöse Meningitis | Therapie der Wahl | Rifampicin | 10 mg/kg KG, max 600 mg | 12 Monate | 10-20% | |
|
|
|
| |||
| Zusatz | Vitamin B6 [1] | 40 mg/d | mit INH | - |
| Patienteneigene |
Klinische Situation | Präferenz | Substanz | Dosierung | Dauer | Liquor Gängigkeit |
|---|---|---|---|---|---|---|
| Tuberkulöse Meningitis | Second line |
|
max 1g i.v.
max 1g i.v.
max 1g i.v.
max 1g i.v.
max 1g i.v.
|
|
|
Zusätzlich zur antituberkulösen Chemotherapie [1[2], 2[3], 5[4], 7[5]] 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[6], 11[7]].
MDR = multi-drug resistance, RMP = Rifampicin
- ↑ Amagon KI, Awodele O, Akindele AJ. Methionine and vitamin B-complex ameliorate antitubercular drugs-induced toxicity in exposed patients. Pharmacol Res Perspect 2017; 5(5)
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen - Update 2018. https://www.awmf.org/leitlinien/detail/ll/082-006.html
- ↑ 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)
- ↑ in Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. 2011; London