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Therapie der Tuberkulose

Treatment of tuberculosis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Durch eine 2-phasige antibiotische Kombinationstherapie, bestehend aus einer intensivierten Behandlung in der Initialphase und einer konsolidierenden Behandlung in der Erhaltungsphase, ist die Tuberkulose in den weitaus meisten Fällen auch bei einer primär bestehenden Antibiotikaresistenz heilbar. Etwa 90% der humanpathogenen Mycobacterium-tuberculosis- (Mtb-)Isolate in Deutschland sind gegenüber den oral verfügbaren Erstrangmedikamenten Isoniazid, Rifampicin, Pyrazinamid und Ethambutol empfindlich. Während die Standardtherapie bei Infektionen mit diesen Stämmen in der Regel 6 Monate beträgt, sollten Patienten mit multiresistenten Mtb-Stämmen 18–24 Monate über den Zeitpunkt der kulturellen Negativierung hinaus behandelt werden. Aufgrund der langen Therapiedauer und häufiger unerwünschter Arzneimittelreaktionen der Reservemedikamente sollten Patienten mit einer multiresistenten Tuberkulose nur von Ärzten an spezialisierten Zentren betreut werden.

Abstract

The vast majority of patients with tuberculosis (TB), including those with primary drug resistance, can nowadays be cured with a biphasic combination antibiotic therapy consisting of an intensive initial period and a consolidating maintenance period. Approximately 90% of Mycobacterium tuberculosis (Mtb) isolates in Germany are sensitive in vitro to the four orally available first-line drugs for treatment: isoniazid, rifampin, ethambutol and pyrazinamide. While the duration of therapy of infections with drug-sensitive strains usually last 6 months, patients with multidrug-resistant (MDR) strains of Mtb should be treated for 18 to 24 months following culture conversion. Due to the long duration of therapy and the high frequency of serious side effects of the medications, patients with MDR strains of Mtb should be treated by experienced physicians at specialized centers only.

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Authors and Affiliations

  1. Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23845, Borstel, Deutschland

    U. Greinert, C. Jafari &  C. Lange

  2. Immunpharmakologie, Medizinische Klinik, Forschungszentrum Borstel, Borstel, Deutschland

    P. Zabel

  3. Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    P. Zabel

Authors
  1. U. Greinert
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  2. C. Jafari
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  3. P. Zabel
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  4. C. Lange
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Correspondence to C. Lange.

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Greinert, U., Jafari, C., Zabel, P. et al. Therapie der Tuberkulose. Pneumologe 4, 175–186 (2007). https://doi.org/10.1007/s10405-007-0147-y

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  • DOI: https://doi.org/10.1007/s10405-007-0147-y

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