{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T01:46:40Z","timestamp":1648518400011},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pneumologie"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Die neue ATS\/ERS\/ESCMID\/IDSA-Leitlinie beantwortet 22 PICO-Fragen zur Behandlung von Erkrankungen der Lunge durch Mycobacterium avium-Komplex (MAC), M. kansasii, M. xenopi und M. abscessus.<\/jats:p><jats:p>\n          Allgemeines\u2002Insbesondere bei Patienten mit mikroskopischem Nachweis s\u00e4urefester St\u00e4bchen im Sputum oder kavern\u00f6ser Verlaufsform sollte der Behandlungsbeginn nicht verz\u00f6gert werden. Die Behandlung sollte auf einer speziesspezifischen Resistenztestung (entsprechend den CLSI-Guidelines) basieren.<\/jats:p><jats:p>\n          MAC-Lungenerkrankung\u2002Die Therapie erfolgt hier mit mindestens 3 Medikamenten inklusive einem Makrolid (eher Azithromycin als Clarithromycin) und Ethambutol. F\u00fcr Patienten mit kavit\u00e4rer, mit ausgepr\u00e4gter nodul\u00e4r-bronchiektatischer Erkrankung oder mit Makrolid-Resistenz wird zur t\u00e4glichen oralen Therapie eine additive Gabe von parenteralem Amikacin oder Streptomycin empfohlen. Liposomal verkapseltes inhalatives Amikacin wird bei Therapieversagen empfohlen. Patienten mit nodul\u00e4r-bronchiektatischer Erkrankungsmanifestation sollten eine orale Makrolid-basierte Therapie, die \u2013 je nach Ausma\u00df \u2013 3\u200a\u00d7\/Woche gegeben werden kann, erhalten. Als Dauer werden 12 Monate nach Konversion der Sputumkultur empfohlen.<\/jats:p><jats:p>\n          \n            M. kansasii-Lungenerkrankung\u2002Empfohlen ist die Dreifachkombination aus Rifampicin, Ethambutol und Makrolid (oder Isoniazid ) f\u00fcr mindestens 12 Monate. Bei Rifampicin-Resistenz oder -unvertr\u00e4glichkeit wird Moxifloxacin als Ersatz empfohlen.<\/jats:p><jats:p>\n          \n            M. xenopi-Lungenerkrankung\u2002Empfohlen ist die Dreifachkombination aus Rifampicin, Ethambutol und Makrolid (oder Moxifloxacin) f\u00fcr mindestens 12 Monate nach Konversion der Sputumkultur. Es wird empfohlen, bei Patienten mit kavern\u00f6ser Verlaufsform zumindest parenterales Amikacin zu addieren und Experten zu konsultieren.<\/jats:p><jats:p>\n          \n            M. abscessus-Lungenerkrankung\u2002Mindestens 3 Medikamente werden zur Therapie empfohlen. Die Substanzauswahl sollte auf einer In-vitro-Resistenztestung basieren. Makrolide sind die Grundlage, sollten aber bei St\u00e4mmen mit induzierbarer Makrolidresistenz nicht mitgerechnet werden. Zur Therapiedauer werden aufgrund fehlender Daten keine expliziten Empfehlungen ausgesprochen, eine Konsultation von Experten wird empfohlen.<\/jats:p>","DOI":"10.1055\/a-1227-9885","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T04:21:34Z","timestamp":1605673294000},"page":"773-779","source":"Crossref","is-referenced-by-count":0,"title":["Lungenerkrankung durch nicht-tuberkul\u00f6se Mykobakterien"],"prefix":"10.1055","volume":"74","author":[{"given":"D.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Abteilung Infektiologie, Klinik f\u00fcr Innere Medizin II, Universit\u00e4tsklinikum Freiburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Lange","sequence":"additional","affiliation":[{"name":"Medizinische Klinik, Forschungszentrum Borstel, Leibniz Lungenzentrum"},{"name":"Tuberkulose Unit, Deutsches Zentrum f\u00fcr Infektionsforschung (DZIF) Braunschweig,"},{"name":"Respiratory Medicine & International Health, Universit\u00e4t zu L\u00fcbeck"},{"name":"Karolinska-Institut, Stockholm, Schweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,11,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2000535","DOI":"10.1183\/13993003.00535-2020","article-title":"Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"56","author":"C L Daley","year":"2020","journal-title":"Eur Respir J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"ciaa241","DOI":"10.1093\/cid\/ciaa241","article-title":"Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS\/ERS\/ESCMID\/IDSA Clinical Practice Guideline: Executive Summary","author":"C L Daley","year":"2020","journal-title":"Clin Infect Dis"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1164\/rccm.200604-571ST","article-title":"ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. 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