Quelltext der Seite DGI:Opportunistische Infektionen/Zerebrale Toxoplasmose/Therapie

==Therapie==
Die Therapie greift den Stoffwechsel der Tachyzoiten an und ist gegen bradyzoitenhaltige Gewebezysten kaum wirksam.

Therapieindikationen bestehen bei aktiver Infektion/Reaktivierung des Immunsupprimierten, okulärer Toxoplasmose, Erstinfektion in der Schwangerschaft und konnataler Infektion. Eine unkomplizierte Erstinfektion bei nicht-schwangeren und immunkompetenten Menschen bedarf regelhaft keiner Therapie.
<br />

===Kalkulierte Therapie===
{| class="wikitable bs-exportable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" align="left" width="723"
|+
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:117.7pt;" width="157" |<span style="font-size:8.0pt;mso-no-proof:yes">'''Klinische Situation'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:80.9pt;" width="108" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Präferenz'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:78.3pt;" width="104" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Substanz'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:82.4pt;" width="110" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Dosierung'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:44.85pt;" width="60" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Dauer'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:65.55pt;" width="87" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Anpassungen'''</span>
| style="border-left-color:#acacac;border-right-color:#acacac;border-top-color:#acacac;border-bottom-color:#acacac;width:72.45pt;" width="97" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">'''Kommentar'''</span>
|- style="height:78.55ptpx;"
| rowspan="8" style="border-top-color:#acacac;width:117.7pt;" width="157" |[https://abbuch.uk-koeln.de/index.php/Therapie_der_HIV-Infektion <span style="color: windowtext">HIV-Infektion</span>] <span style="font-size:8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-no-proof:yes">(CD4 Zellzahl <  100/µl) ohne effektive Prophylaxe, allogene Stammzell- und  Organtransplantation</span>
| rowspan="3" style="border-top-color:#acacac;width:80.9pt;" width="108" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Wenn <span style="mso-spacerun:yes"> </span>Serologie<sup>2</sup>, MRT, CT mit Kontrastmittel  (Liquor- PCR)<sup>3</sup>, Histologie : Therapie der 1. Wahl</span>
| style="border-top-color:#acacac;width:78.3pt;" width="104" valign="top" |[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Pyrimethamin <span style="color: windowtext">Pyrimethamin</span>]

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">dann</span>

[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Pyrimethamin <span style="color: windowtext">Pyrimethamin</span>]
| style="border-top-color:#acacac;width:82.4pt;" width="110" valign="top" |<span style="font-size:8.0pt;line-height:300%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
  Arial;mso-bidi-theme-font:minor-bidi;mso-no-proof:yes">1 x 200 mg p.o.</span>

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">< 60 kg 1 x 50 mg p.o.</span>

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">≥ 60 kg 1 x 75 mg p.o.</span>
| rowspan="3" style="border-top-color:#acacac;width:44.85pt;" width="60" |<span style="color: #333333">Therapie  in angegebener Dosis für ca. 6 Wochen</span>
| rowspan="3" style="border-top-color:#acacac;width:65.55pt;" width="87" |<span style="color: #333333">Blutbildkontrollen  aufgrund Risiko der Myelosuppression; Vorsicht bei Nieren- oder  Leberfunktionsstörung; Sulfadiazin bei schwerer Nieren- oder  Leberfunktionsstörung kontraindiziert;Kristallurie mit akutem Nierenversagen  möglich</span>
| rowspan="3" style="border-top-color:#acacac;width:72.45pt;" width="97" |<span style="color: #333333">Im  Anschluss an Therapie in voller Dosis Erhaltungstherapie in halber Dosierung  für mind. 3 Monate (in Abhängigkeit von Bildgebung und CD4+ Zellzahl)</span>
|- style="height:32.3ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" | +

Calciumfolinat

| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" |1 x  15 mg p.o.
|- style="height:16.0ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" valign="top" | +



[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Sulfadiazin Sulfadiazin]
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" |4 x  1 - 1,5 g p.o.
|- style="height:19.4ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:80.9pt;" width="108" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Wenn <span style="mso-spacerun:yes"> </span>Liquorprotein > 1 g/dl oder  Chorioretinitis: Therapie der 1. Wahl</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">s.o. +</span>

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Prednison</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="top" |2 x 500  µg/kg p.o.
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:44.85pt;" width="60" valign="bottom" |
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:65.55pt;" width="87" |
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:72.45pt;" width="97" |
|- style="height:28.05ptpx;"
| rowspan="4" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:80.9pt;" width="108" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Allergie/</span>

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Unverträglichkeit</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |[https://abbuch.uk-koeln.de/index.php/Antibiotika#Clindamycin <span style="color: windowtext">Clindamycin</span>]

<span style="font-size:8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-no-proof:yes">oder</span>

[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Atovaquon <span style="color: windowtext">Atovaquon</span>]
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="top" |<span style="font-size:8.0pt;line-height:200%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
  Arial;mso-bidi-theme-font:minor-bidi;mso-no-proof:yes">2 x 1,2 g p.o./i.v.</span>

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">2 x 1,5 g p.o.</span>
| rowspan="4" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:44.85pt;" width="60" |
| rowspan="4" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:65.55pt;" width="87" |<span style="color: #333333">Blutbildkontrollen  aufgrund Risiko der Myelosuppression;   Vorsicht bei Nieren- oder Leberfunktionsstörung</span>
| rowspan="4" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:72.45pt;" width="97" |
|- style="height:28.75ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">mit einer Mahlzeit jeweils</span> 

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">+</span>

[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Pyrimethamin <span style="color: windowtext">Pyrimethamin</span>]
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="bottom" |1 x  200 mg p.o.
|- style="height:29.4ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |dann

[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Pyrimethamin Pyrimethamin]
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="bottom" |<  60 kg 1 x 50 mg p.o.

≥ 60 kg 1 x 75 mg p.o.
|- style="height:1.45ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" | +

Calciumfolinat
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="bottom" |1 x  15 mg p.o.
|- style="height:24.35ptpx;"
| rowspan="3" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:117.7pt;" width="157" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">konnatal erworben, symptomatisch</span>
| rowspan="3" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:80.9pt;" width="108" |
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Pyrimethamin <span style="color: windowtext">Pyrimethamin</span>]

<span style="font-size:8.0pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:
  DE;mso-no-proof:yes">+</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" |<span style="font-size:
  8.0pt;mso-no-proof:yes">1 </span><span style="font-size:8.0pt;font-family:
  &quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:
  minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;
  mso-no-proof:yes">x 1 mg/kgKG p.o.</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:44.85pt;" width="60" |
| rowspan="3" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:65.55pt;" width="87" |<span style="color: #333333">Spiegelbestimmung,  v.a. bei Hinweis auf Myelosuppression;   Vorsicht bei Nieren- oder Leberfunktionsstörung Sulfadiazin bei  schwerer Nieren- oder Leberfunktionsstörung kontraindiziert; Kristallurie mit  akutem Nierenversagen möglich</span>
| rowspan="3" style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:72.45pt;" width="97" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Bei asymptomatischen  Neugeborenen (nur Labornachweis der Infektion), ggf. Kurzzeittherapie über  3-6 Monate erwägen</span>
|- style="height:12.8ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" valign="bottom" |[https://abbuch.uk-koeln.de/index.php/Antiparasit%C3%A4re_Substanzen#Sulfadiazin <span style="color: windowtext">Sulfadiazin</span>]

<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">+</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="top" |100  mg /kgKG p.o. 2 ED
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:44.85pt;" width="60" |
|- style="height:12.8ptpx;"
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:78.3pt;" width="104" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">Calciumfolinat</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:82.4pt;" width="110" valign="bottom" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">10 mg/Woche p.o. 2 ED</span>
| style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;width:44.85pt;" width="60" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-no-proof:yes">für 12 Monate</span>
|}
                                                                               
 
<span style="color: black">Bei Erstinfektion in der Schwangerschaft erfolgt eine materno-fetale Therapie. Vor der 16. Schwangerschaftswoche dürfen Folsäureantagonisten nicht eingesetzt werden, so dass hier eine Behandlung mit Spiramycin (3 g = 9 MIU/Tag) erfolgt. Ab der 16. Schwangerschaftswoche erfolgt die Behandlung mit Pyrimethamin (50 mg an Tag 1, dann 25 mg/Tag), Sulfadiazin (50 mg/kg KG/Tag) und Folinsäure (10-15 mg/Tag; nicht Folsäure!) für mindestens 4 Wochen. Bei sonographischen Hinweisen auf eine Infektion des Feten sollte die Behandlung bis zum Ende der Schwangerschaft fortgeführt werden.</span>

<br />

===Erregerspezifische Therapie===
<span class="toctext"><span style="color: black">Siehe 5.1.</span></span><br />