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Therapie von pulmonalen Infektionen durch nicht-tuberkulöse Mykobakterien

Treatment of pulmonary infections due to nontuberculous mycobacteria

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Zusammenfassung

Die Indikation zur Behandlung pulmonaler Erkrankungen durch nicht-tuberkulöse Mykobakterien (NTM) hängt neben klinischen, radiologischen und mikrobiologischen Kriterien v. a. von der Art und dem Ausmaß der Erkrankung, dem Zustand des betroffenen Patienten sowie der Virulenz und Suszeptibilität der Mykobakterien-Spezies gegenüber einer antibiotischen Therapie ab. Die Behandlung von Erkrankungen durch NTM richtet sich nach den Empfehlungen der „American Thoracic Society“ (ATS) und der „Infectious Disease Society of America“ (IDSA). Die speziesspezifische antibiotische Kombinationstherapie der NTM-Erkrankungen ist langwierig und muss häufig wegen auftretender Nebenwirkungen geändert oder abgebrochen werden. Der Therapieerfolg ist sehr variabel und abhängig von der NTM-Spezies. Im Falle des Nichtansprechens der medikamentösen Behandlung kann bei geeigneten Kandidaten mit lokalisierten Erkrankungen durch chirurgische Interventionen der Therapieerfolg verbessert werden. Biomarker, die eine individuelle Aussage über einen Behandlungserfolg erlauben und damit die Therapiedauer beeinflussen, sind bislang nicht identifiziert.

Abstract

The indication to initiate treatment of pulmonary diseases caused by nontuberculous mycobacteria (NTM) depends on clinical, radiological, and microbiological criteria, the nature and severity of the disease, the overall condition of the patient, as well as the virulence and susceptibility of the mycobacteria to combination antibiotic therapy. The treatment of NTM diseases is guided by the statement of the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). The species-specific combination antibiotic therapy of NTM diseases is long-lasting and often has to be altered or terminated due to the occurrence of adverse drug events. The treatment outcome is variable and depends on the causative NTM species. In suitable candidates the outcome can be improved by surgical interventions if the patient is not getting better on medical therapy alone and the disease is localized. Biomarkers that allow treatment success to be defined and therefore influence the individual duration of therapy have not been identified so far.

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Authors and Affiliations

  1. Tuberkulosezentrum, Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Parkallee 35, 23945, Borstel, Deutschland

    C. Lange & U. Greinert FIDSA

  2. Zentrum für Pneumologie, Diakoniekrankenhaus Rotenburg, Rotenburg, Deutschland

    T. Schaberg

Authors
  1. C. Lange
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  2. U. Greinert FIDSA
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  3. T. Schaberg
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Correspondence to C. Lange.

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Lange, C., Greinert, U. & Schaberg, T. Therapie von pulmonalen Infektionen durch nicht-tuberkulöse Mykobakterien. Pneumologe 8, 418–429 (2011). https://doi.org/10.1007/s10405-011-0487-5

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