DGI:Knochen-, Gelenks- und Protheseninfektionen/Spondylodiszitis/Therapie/Erregerspezifische Therapie: Difference between revisions

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Die Therapie der Spondylodiszitis sollte möglichst gezielt Erreger-bezogen erfolgen:
Die Therapie der Spondylodiszitis sollte möglichst gezielt Erreger-bezogen erfolgen:
{| class="wikitable sortable mw-collapsible MsoTableGrid jquery-tablesorter" border="1" cellspacing="0" cellpadding="0" width="888" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(248, 249, 250); font-size: 14px; color: rgb(34, 34, 34); margin: 1em 0px; border: none; 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;"
| style="vertical-align:middle;width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Erreger'''</span>
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Präferenz'''</span>
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Substanz'''</span>
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit; font-size: 9pt;">'''Dosierung'''</span>
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |<span class="mw-collapsible-toggle mw-collapsible-toggle-default" role="button" style="box-sizing: inherit; cursor: pointer; float: right; user-select: none;" tabindex="0">Einklappen</span><span style="box-sizing: inherit; font-size: 9pt;">'''Kommentar'''</span>
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Flucloxacillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Intravenöse Initialtherapie
1. Wahl
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Cefazolin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 2 g i.v.
| style="vertical-align:middle;" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |*
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Alternative bei schwerer Allergie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 8 – 10** mg/kg i.v.
| style="vertical-align:middle;" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
<nowiki>**</nowiki> hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">plus</span>
<span style="box-sizing: inherit;">Rifampicin</span>
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 600 mg i.v. bzw.
2 x 450 mg p.o.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |wegen sehr guter Bioverfügbarkeit orale Gabe bevorzugen
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |bei Fremdmaterial-assoziierter Infektion
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |alternativ
plus
Fosfomycin <span style="box-sizing: inherit;">           </span>
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 5 g i.v.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Cotrimoxazol
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 960 mg p.o
|
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Clindamycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 600 mg p.o
|
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Doxycyclin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 100 mg p.o.
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Orale Anschlusstherapie
''ohne'' Fremdmaterial
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Levofloxacin
plus
Rifampicin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 500 mg p.o.
plus
2 x 450 mg p.o.
| style="vertical-align:middle;" |'''Cave:''' wegen schlechter Bioverfügbarkeit orale Betalaktame meiden.
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Cotrimoxazol
plus
Rifampicin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 960 mg p.o.
plus
2 x 450 mg p.o.
|
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Doxycyclin
plus
Rifampicin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 100 mg p.o.
plus
2 x 450 mg p.o.
|
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Staphylococcus aureus
und andere Staphylokokken,
Oxacillin-sensibel
| style="vertical-align:middle;" |Orale Anschlusstherapie
bei ''Fremdmaterial''-assoziierter Infektion
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Levofloxacin
plus
Rifampicin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 500 mg p.o.
plus
2 x 450 mg p.o.
| style="vertical-align:middle;" |möglichst keine Kombination von Rifampicin mit Clindamycin oder Linezolid
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |*
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 8 – 10** mg/kg i.v.
| style="vertical-align:middle;" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
<nowiki>**</nowiki> hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">plus</span>
<span style="box-sizing: inherit;">Rifampicin</span>
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 600 mg i.v. bzw.
2 x 450 mg p.o.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |wegen sehr guter Bioverfügbarkeit orale Gabe bevorzugen
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |bei ''Fremdmaterial''-assoziierter Infektion
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |alternativ
plus
Fosfomycin <span style="box-sizing: inherit;">           </span>
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 5 g i.v.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Staphylococcus aureus
und andere Staphylokokken,
Oxacillin-resistent
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| colspan="3" style="vertical-align:middle;width:432.35pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="576" valign="top" |s.oben
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
1.Wahl
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ampicillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |'''*'''
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Alternativen
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 10 - 12 mg/kg <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="0" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="1" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="2" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span></span> i.v.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Enterococcus spp.,
Ampicillin-sensibel
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Amoxicillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 1 g p.o.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Vancomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |'''*'''
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |*[[:Datei:DGI:Infoblatt Vancomycin RGU.pdf]]
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Daptomycin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 10 - 12 mg/kg <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="3" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="4" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="5" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span></span> i.v.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |hohe Dosis off-label, Expertenmeinung
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Enterococcus spp.,
Ampicillin-resistent
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Linezolid
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 600 mg p.o.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |Linezolid max. 28 Tage zugelassen
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Benzylpenicillin (Penicillin G)
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">4 x 5 Mio I.E. i.v.                                    </span>
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Streptokokken
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Amoxicillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">3 x 1 g p.o.</span>
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ampicillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |6 x 2 g i.v.
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ceftriaxon
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |1 x 2 g i.v.
| style="vertical-align:middle;" |
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Enterobakterien
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ciprofloxacin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 750 mg p.o
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
|
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Piperacillin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |4 x 4 g i.v.
|
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |oder
Ceftazidim
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |3 x 2 g i.v.
| style="vertical-align:middle;" |Bei Pseudomonas-Infektionen immer hohe Dosis verwenden.
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Pseudomonas aeruginosa
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Ciprofloxacin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |2 x 750 mg p.o.
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
|
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Intravenöse Initialtherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Caspofungin
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |Tag 1: <span style="box-sizing: inherit;">                       </span>
1 x 70 mg i.v.,
danach: 1 x 50 mg i.v. <span style="box-sizing: inherit;">                <span style="box-sizing: inherit;"> </span></span><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="6" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="7" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="8" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span></span> ≤ 80 kg
bzw. 1 x 70 mg i.v. <span style="box-sizing: inherit;">           </span> <span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="9" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="10" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;"><span class="mw-lingo-term" data-lingo-term-id="56d721ccadb8bbfd8b47390d82a6ea4b" data-hasqtip="11" style="box-sizing: inherit; border-bottom: 1px dotted rgb(187, 187, 255); cursor: default;">KG</span></span></span> > 80 kg
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="vertical-align:middle;" |Candida spp.
''<span style="box-sizing: inherit;">'''     '''</span>''
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Orale Anschlusstherapie
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |Fluconazol
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |<span style="box-sizing: inherit;">Einmalig 1 x 800 mg p.o.,</span>
<span style="box-sizing: inherit;">weiter mit 1 x 400 mg p.o.</span>
| style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| rowspan="2" style="vertical-align:middle;width:113.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="151" valign="top" |Mycobacterium tuberculosis
| style="vertical-align:middle;width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Initialtherapie 2 Monate
| style="vertical-align:middle;width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">Isoniazid (in Kombi mit Pyridoxin)</span>
plus Rifampicin plus Pyrazinamid plus Ethambutol
| style="vertical-align:middle;width:5cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="189" valign="top" |s. Dosierungsempfehlung Link Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose
| rowspan="2" style="vertical-align:middle;width:7cm;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="265" valign="top" |
|- style="box-sizing: inherit;"
| style="width:120.5pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="161" valign="top" |Anschlusstherapie
| style="width:92.15pt;box-sizing:inherit;padding:0.2em 0.4em;border:1px solid rgb(162, 169, 177);" width="123" valign="top" |<span style="box-sizing: inherit;">Isoniazid (in Kombi mit Pyridoxin)</span>
<span style="box-sizing: inherit;">plus R</span>ifampicin
|}




Revision as of 16:44, 17 March 2022

Die Therapie der Spondylodiszitis sollte möglichst gezielt Erreger-bezogen erfolgen:


Bezüglich Substanz und Therapiedauer fehlen randomisierte Studien, die Empfehlungen beruhen auf den vorhandenen Leitlinien, die sich überwiegend auf Expert:innenmeinungen bzw. Ableitungen von ähnlichen Infektionsfoci beziehen.

Bei Fremdmaterial-assoziierter Spondylodiszitis sollte die Therapie bei noch vorhandenem Fremdmaterial eine biofilmaktive Substanz beinhalten (z.B. Rifampicin bzw. Fosfomycin i.v. bei Staphylokokken), wobei zu beachten ist, dass Rifampicin und Fosfomycin bei diesem Krankheitsbild niemals als Monotherapie gegeben werden sollen (Gefahr der schnellen Resistenzentwicklung). Die Entfernung/Wechsel des Implantates sollte diskutiert werden.

Bei zusätzlichem Nachweis einer Endokarditis sollte die Antibiotikatherapie entsprechend der Endokarditis-Leitlinien erfolgen und anschließend entsprechend der o.g. Empfehlungen zur Spondylodiszitis Therapie verlängert werden (s. orale Anschlusstherapie).

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