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Update zur Therapie der Tuberkulose im Kindesalter

Update on the treatment of tuberculosis in children

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Zusammenfassung

Hintergrund

Die Prävention, Diagnostik und Behandlung von Tuberkuloseerkrankungen im Kindesalter stellen weiterhin eine Herausforderung dar.

Prävention und Therapie

Aufgrund des erhöhten Risikos für schwere Erkrankungsformen der Tuberkulose (Tb) wird bei Kindern unter 5 Jahren bei Exposition zu Personen mit einer infektiösen Tb unabhängig von den initialen immunologischen Testergebnissen immer eine prophylaktische Chemotherapie mit Isoniazid (INH) über 3 Monate empfohlen. Bei asymptomatischer (latenter) Infektion sollten entweder INH über 9 Monate gegeben oder die Kombinationsbehandlung mit INH und Rifampicin (RMP) über 3 Monate durchgeführt werden. Im Fall der im Kindesalter überwiegend paucibazillären unkomplizierten Primär-Tb ist initial eine 3-Fach-Kombinationstherapie ausreichend.

Schlussfolgerung

Insbesondere bei Kleinkindern sind die zeitnahe Diagnosestellung und Initiierung einer effektiven Therapie zur Verhinderung schwerer Krankheitsverläufe von entscheidender Bedeutung. Die weltweite Zunahme multiresistenter Keime stellt eine therapeutische Herausforderung dar. Die Betreuung dieser Kinder und Jugendlichen sollte spezialisierten Zentren vorbehalten bleiben.

Abstract

Background

Prevention, diagnosis and therapy of tuberculosis in children remain a challenge.

Prevention and therapy

Due to increased risk of disease progression after infection, prophylactic treatment with isoniazid (INH) for 3 months in children < 5 years is indicated after contact with infectious patients. Preventive therapy with INH for 9 months or INH and RMP for 3 months is indicated in asymptomatic tuberculosis infection in all children and adolescents. Uncomplicated primary tuberculosis in children can sufficiently be treated with an initial combination of three drugs.

Conclusion

Especially in small children, rapid diagnosis and treatment is crucial because of an increased risk of disseminated tuberculosis. Drug-resistant tuberculosis is challenging and requires specialist expertise.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Brinkmann und S. Thee geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    F. Brinkmann

  2. Kinderklinik, DRK Kliniken Westend, Berlin, Deutschland

    S. Thee

  3. Klinik für Pädiatrie m. S. Pädiatrische Pneumologie und Immunologie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Deutschland

    S. Thee

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  1. F. Brinkmann
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  2. S. Thee
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Correspondence to F. Brinkmann.

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Brinkmann, F., Thee, S. Update zur Therapie der Tuberkulose im Kindesalter. Monatsschr Kinderheilkd 162, 122–129 (2014). https://doi.org/10.1007/s00112-013-2964-x

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