DGI:ZNS-Infektionen/Tuberkulose Meningitis/Therapie

Therapie


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%
		Isoniazid	5 mg/kg KG	12 Monate	80-90%
		Pyrazinamid	25 mg/kg KG	Ersten 2 Monate	90-100%
		Ethamutolb	*15 mg/kg KG	Ersten 2 Monate	20-30%
	Zusatz	Vitamin B6 ^[1]	40 mg/d	mit INH	-


Klinische Situation	Substanz	Dosierung	Dauer	Liquor Gängigkeit
Tuberkulöse Meningitis	Second line	Levofloxacin	10-15 mg/kg	durchgängig	70-80%
		Moxifloxacin	400mg	durchgängig	70-80%
		Amikacin	15 mg/kg, max 1g i.v.	Intensivphase	10-20%
		Kanamycin	15 mg/kg, max 1g i.v.	Intensivphase	10-20%
		Capreomycin	15 mg/kg, max 1g i.v.	Intensivphase	Keine Daten
		Ethionamid	15-20 mg/kg, max 1g i.v.	durchgängig	80-90%
		Cycloserin	10-20 mg/kg, max 1g i.v.	durchgängig	80-90%
		Linezolid	600 mg	durchgängig	30-70%

Zusätzlich zur antituberkulösen Chemotherapie ^[2]^[3]^[4]^[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 ^[6]^[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)
↑ Schaberg T et al. Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP). Pneumologie 2017; 71(6): 325-397
↑ Wilkinson RJ et al. Tuberculous meningitis. Nat Rev Neurol 2017; 13(10): 581-598
↑ Thwaites G et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 2009; 59(3): 167-87
↑ Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract 2014; 4(3):199-205
↑ Prasad K, Singh MB. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev 2008(1); CD002244
↑ Thwaites GE et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351(17): 1741-51

[1] 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)

[2] Schaberg T et al. Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP). Pneumologie 2017; 71(6): 325-397

[3] Wilkinson RJ et al. Tuberculous meningitis. Nat Rev Neurol 2017; 13(10): 581-598

[4] Thwaites G et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 2009; 59(3): 167-87

[5] Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract 2014; 4(3):199-205

[6] Prasad K, Singh MB. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev 2008(1); CD002244

[7] Thwaites GE et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351(17): 1741-51

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