Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Die Folgen des Klimwandels haben einen direkten Einfluss auf die Primärversorgung in Deutschland: Hitzeschutz insbesondere bei älteren Patienten, die Zunahme von Infektionen und die Verlängerung der Allergiesesaison spielen medizinisch eine bedeutsame Rolle. Aber auch in der Prävention und der Aufklärung der Patienten kommt den Hausärztinnen und -ärzten eine besondere Rolle zu. Direkt aus der Praxis berichtet im Live-Webinar am 13. Mai von 18 bis 19 Uhr unser Experte Dr. med. Robin Maitra.
Erweiterte Suche
Anmelden
nach oben
Pediatric Drugs
Erschienen in: Pediatric Drugs 3/2005

01.05.2005 | Therapy In Practice

Tick-Borne Infections in Children

Epidemiology, Clinical Manifestations, and Optimal Management Strategies

verfasst von: Dr Steven C. Buckingham

Erschienen in: Pediatric Drugs | Ausgabe 3/2005

Einloggen, um Zugang zu erhalten

Abstract

Ticks can transmit bacterial, protozoal, and viral infections to humans. Specific therapy is available for several of these infections. Doxycycline is the antimicrobial treatment of choice for all patients, regardless of age, with Rocky Mountain spotted fever, human monocytic ehrlichiosis, or human granulocytic ehrlichiosis. Chloramphenicol has been used to treat these infections in children but is demonstrably inferior to doxycycline. In patients with Mediterranean spotted fever, doxycycline, chloramphenicol, and newer macrolides all appear to be effective therapies. Therapy of Lyme disease depends on the age of the child and stage of the disease. For early localized disease, amoxicillin (for those aged <8 years) or doxycycline (for those aged ≥8 years) is effective. Doxycycline, penicillin V (phenoxymethylpenicillin) or penicillin G (benzylpenicillin) preparations, and erythromycin are all effective treatments for tick-borne relapsing fever. Hospitalized patients with tularemia should receive gentamicin or streptomycin. Doxycycline and ciprofloxacin have each been investigated for the treatment of tularemia in outpatients; however, these agents do not yet have established roles in the treatment of this disease in children. Combination therapy with clindamycin and quinine is preferred for children with babesiosis; the combination of azithromycin and atovaquone also appears promising. Ribavirin has been recently shown to markedly improve survival in patients with Crimean-Congo hemorrhagic fever. The role of antiviral therapy in the treatment of other tick-borne viral infections, including other hemorrhagic fevers and tick-borne encephalitis, is not yet defined.
Literatur
1.
Sonenshine DE, Azad AF. Ticks and mites in disease transmission. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 992–1003
2.
Spach DH, Liles WC, Campbell GL, et al. Tick-borne diseases in the United States. N Engl J Med 1993; 329: 936–47PubMedCrossRef
3.
American Academy of Pediatrics. Prevention of tick-borne infections. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 186–7
4.
McDade JE, Newhouse VF. Natural history of Rickettsia rickettsii. Annu Rev Microbiol 1986; 40: 287–309PubMedCrossRef
5.
Dalton MJ, Clarke MJ, Holman RC, et al. National surveillance for Rocky Mountain spotted fever, 1981–1992: epidemiologic summary and evaluation of risk factors for fatal outcome. Am J Trop Med Hyg 1995; 52: 405–13PubMed
6.
Treadwell TA, Holman RC, Clarke MJ, et al. Rocky Mountain spotted fever in the United States, 1993–1996. Am J Trop Med Hyg 2000; 63: 21–6PubMed
7.
Brouqui P. Tick-borne rickettsioses of the eastern hemisphere. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 438–41
8.
Raoult D, Roux V. Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev 1997; 10: 694–719PubMed
9.
Strickland GT, Olson JG. Ehrlichiosis. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 445–8
10.
Jacobs RF. Human monocytic ehrlichiosis: similar to Rocky Mountain spotted fever but different. Pediatr Ann 2002; 31: 180–4PubMed
11.
Dumler JS, Barbet AF, Bekker CP, et al. Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales: unification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and ‘HGE agent’ as subjective synonyms of Ehrlichia phagocytophila. Int J Syst Evol Microbiol 2001; 51: 2145–65PubMedCrossRef
12.
13.
Stechenberg BW. Borrelia (Lyme disease). In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases. 4th ed. Philadelphia (PA): WB Saunders, 1998: 1522–7
14.
Kirkland KB, Klimko TB, Meriwether RA, et al. Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease? Arch Intern Med 1997; 157: 2635–41PubMedCrossRef
15.
Campbell GL, Paul WS, Schriefer ME, et al. Epidemiologic and diagnostic studies of patients with suspected early Lyme disease, Missouri, 1990–1993. J Infect Dis 1995; 172: 470–80PubMedCrossRef
16.
Masters E, Granter S, Duray P, et al. Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites. Arch Dermatol 1998; 134: 955–60PubMedCrossRef
17.
Felz MW, Chandler Jr FW, Oliver Jr JH, et al. Solitary erythema migrans in Georgia and South Carolina. Arch Dermatol 1999; 135: 1317–26PubMedCrossRef
18.
James AM, Liveris D, Wormser GP, et al. Borrelia lonestari infection after a bite by an Amblyomma americanum tick. J Infect Dis 2001; 183: 1810–4PubMedCrossRef
19.
American Academy of Pediatrics. Borrelia (relapsing fever). In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 220–2
20.
Butler T. Relapsing fever. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 448–52
21.
Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat [published erratum appears in Clin Infect Dis 2001; 33: 749]. Clin Infect Dis 2001; 32: 897–928PubMedCrossRef
22.
American Academy of Pediatrics. Tularemia. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 666–7
23.
Bryant KA. Tularemia: lymphadenitis with a twist. Pediatr Ann 2002; 31: 187–90PubMed
24.
American Academy of Pediatrics. Babesiosis. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 211–2
25.
Herwaldt BL. Babesiosis. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 688–90
26.
Lantos PM, Krause PJ. Babesiosis: similar to malaria but different. Pediatr Ann 2002; 31: 192–7PubMed
27.
McCormick JB, Fisher-Hoch SP. Crimean-Congo hemorrhagic fever. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 284–7
28.
Gritsun TS, Lashkevich VA, Gould EA. Tick-borne encephalitis. Antiviral Res 2003; 57: 129–46PubMedCrossRef
29.
Aebi C, Tsai TF. Tick-borne encephalitis. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases. 4th ed. Philadelphia (PA): WB Saunders, 1998: 2003–8
30.
31.
Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985; 75: 997–1002PubMed
32.
Insect repellants. Med Lett Drugs Ther 2003; 45: 41–2
33.
Fradin MS. Mosquitoes and mosquito repellants: a clinician’s guide. Ann Intern Med 1998; 128: 931–40PubMed
34.
35.
Rolain JM, Maurin M, Vestris G, et al. In vitro susceptibilities of 27 rickettsiae to 13 antimicrobials. Antimicrob Agents Chemother 1998; 42: 1537–41PubMed
36.
Bradford WD, Hawkins HK. Rocky Mountain spotted fever in childhood. Am J Dis Child 1977; 131: 1228–32PubMed
37.
Heimick CG, Bernard KW, D’Angelo LJ. Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. J Infect Dis 1984; 150: 480–8CrossRef
38.
Buckingham SC. Rocky Mountain spotted fever: a review for the pediatrician. Pediatr Ann 2002; 31: 163–8PubMed
39.
American Academy of Pediatrics. Rocky Mountain spotted fever. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 532–4
40.
Hattwick MAW, Retailliau H, O’Brien RJ, et al. Fatal Rocky Mountain spotted fever. JAMA 1978; 240: 1499–503PubMedCrossRef
41.
Holman RC, Paddock CD, Curns AT, et al. Analysis of risk factors for fatal Rocky Mountain spotted fever: evidence for superiority of tetracyclines for therapy. J Infect Dis 2001; 184: 1437–44PubMedCrossRef
42.
Smith M, Unkel JH, Fenton SJ, et al. The use of tetracyclines in pediatric patients. J Pediatr Pharmacol Ther 2001; 6: 66–71
43.
Lochary ME, Lockhart PB, Williams WT. Doxycycline and staining of permanent teeth. Pediatr Infect Dis J 1998; 17: 429–31PubMedCrossRef
44.
Forti G, Benincori C. Doxycycline and the teeth. Lancet 1969; I: 782–3CrossRef
45.
Anton E, Font B, Munoz T, et al. Clinical and laboratory characteristics of 144 patients with Mediterranean spotted fever. Eur J Clin Microbiol Infect Dis 2003; 22: 126–8PubMed
46.
Font-Creus B, Bella-Cueto F, Espejo-Arenas E, et al. Mediterranean spotted fever: a cooperative study of 227 cases. Rev Infect Dis 1985; 7: 635–42PubMedCrossRef
47.
Raoult D, Weiller PJ, Chagnon A, et al. Mediterranean spotted fever: clinical, laboratory and epidemiological features of 199 cases. Am J Trop Med Hyg 1986; 35: 845–50PubMed
48.
Bella-Cueto F, Font-Creus B, Segura-Porta F, et al. Comparative, randomized trial of one-day doxycycline versus 10-day tetracycline therapy for Mediterranean spotted fever. J Infect Dis 1987; 155: 1056–8PubMedCrossRef
49.
Ruiz Beltran R, Herrero Herrero JI. Evaluation of ciprofloxacin and doxycycline in the treatment of Mediterranean spotted fever. Eur J Clin Microbiol Infect Dis 1992; 11: 427–31PubMedCrossRef
50.
Cascio A, Dones P, Romano A, et al. Clinical and laboratory findings of boutonneuse fever in Sicilian children. Eur J Pediatr 1998; 157: 482–6PubMedCrossRef
51.
Munoz-Espin T, Lopez-Pares P, Espejo-Arenas E, et al. Erythromycin versus tetracycline for treatment of Mediterranean spotted fever. Arch Dis Child 1986; 61: 1027–9PubMedCrossRef
52.
Bella F, Font B, Uriz S, et al. Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever. Antimicrob Agents Chemother 1990; 34: 937–8PubMedCrossRef
53.
Meloni G, Meloni T. Azithromycin vs. doxycycline for Mediterranean spotted fever. Pediatr Infect Dis J 1996; 15: 1042–4PubMedCrossRef
54.
Cascio A, Colomba C, Antinori S, et al. Clarithromycin versus azithromycin in the treatment of Mediterranean spotted fever in children: a randomized controlled trial. Clin Infect Dis 2002; 34: 154–8PubMedCrossRef
55.
Ruiz Beltran R, Herrero Herrero JI. Deleterious effect of trimethoprim-sulfamethoxazole in Mediterranean spotted fever. Antimicrob Agents Chemother 1992; 36: 1342–3PubMedCrossRef
56.
Raoult D, Lakos A, Fenollar F, et al. Spotless rickettsiosis caused by Rickettsia slovaca and associated with Dermacentor ticks. Clin Infect Dis 2002; 34: 1331–6PubMedCrossRef
57.
Maeda K, Markowitz N, Hawley RC, et al. Human infection with Ehrlichia cams, a leukocytic rickettsia. N Engl J Med 1987; 316: 853–6PubMedCrossRef
58.
Fishbein DB, Dawson JE, Robinson LE. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med 1994; 120: 736–43PubMed
59.
60.
American Academy of Pediatrics. Ehrlichiosis. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 266–9
61.
Brouqui P, Raoult D. In vitro antibiotic susceptibility of the newly recognized agent of ehrlichiosis in humans, Ehrlichia chaffeensis. Antimicrob Agents Chemother 1992; 36: 2799–803PubMedCrossRef
62.
Fichtenbaum CJ, Peterson LR, Weil GJ. Ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome. Am J Med 1993; 95: 351–7PubMedCrossRef
63.
Patel RG, Byrd MA. Near fatal acute respiratory distress syndrome in a patient with human ehrlichiosis. South Med J 1999; 92: 333–5PubMedCrossRef
64.
Peters TR, Edwards KM, Standaert SM. Severe ehrlichiosis in an adolescent taking trimethoprim-sulfamethoxazole. Pediatr Infect Dis J 2000; 19: 170–2PubMedCrossRef
65.
Brantley RK. Trimethoprim-sulfamethoxazole and fulminant ehrlichiosis [letter]. Pediatr Infect Dis J 2001; 20: 231PubMed
66.
Bakken JS, Dumler JS, Chen SM, et al. Human granulocytic ehrlichiosis in the upper midwest United States: a new species emerging? JAMA 1994; 272: 212–8PubMedCrossRef
67.
Bakken JS, Krueth J, Wilson-Nordskog C, et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA 1996; 275: 199–205PubMedCrossRef
68.
Maurin M, Bakken JS, Dumler JS. Antibiotic susceptibilities of Anaplasma (Ehrlichia) phagocytophilum strains from various geographic areas in the United States. Antimicrob Agents Chemother 2003; 47: 413–5PubMedCrossRef
69.
Buitrago MI, Ijdo JW, Rinaudo P, et al. Human granulocytic ehrlichiosis during pregnancy treated successfully with rifampin. Clin Infect Dis 1998; 27: 213–5PubMedCrossRef
70.
Buller RS, Arens M, Hmiel SP. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med 1999; 341: 148–55PubMedCrossRef
71.
Storch GA. New developments in tick-borne infections. Pediatr Ann 2002; 31: 200–4PubMed
72.
American Academy of Pediatrics. Lyme disease. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 407–11
73.
Wormser GP, Nadelman RB, Dattwyler RJ, et al. Practice guidelines for the treatment of Lyme disease: the Infectious Diseases Society of America. Clin Infect Dis 2000; 31(1 Suppl.): 1–14PubMedCrossRef
74.
Terekhova D, Sartakova ML, Wormser GP, et al. Erythromycin resistance in Borrelia burgdorferi. Antimicrob Agents Chemother 2002; 46: 3637–40PubMedCrossRef
75.
Luft BJ, Dattwyler RJ, Johnson RC, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans: a double-blind, randomized, controlled trial. Ann Intern Med 1996; 124: 785–91PubMed
76.
Eppes SC, Childs JA. Comparative study of cefuroxime axetil versus amoxicillin in children with early Lyme disease. Pediatrics 2002; 109: 1173–7PubMedCrossRef
77.
Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 85–92PubMedCrossRef
78.
Patel R, Grogg KL, Edwards WD, et al. Death from inappropriate therapy for Lyme disease. Clin Infect Dis 2000; 31: 1107–9PubMedCrossRef
79.
80.
Nadelman RB, Nowakowski J, Fish D, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med 2001; 345: 79–84PubMedCrossRef
81.
Dworkin MS, Anderson DE, Schwan TG, et al. Tick-borne relapsing fever in the northwestern United States and southwestern Canada. Clin Infect Dis 1998; 26: 122–31PubMedCrossRef
82.
Stewart SJ. Francisella. In: Murray PR, editor. Manual of clinical microbiology. Washington (DC): ASM Press, 1995: 545–8
83.
Enderlin G, Morales L, Jacobs RF, et al. Streptomycin and alternative agents for the treatment of tularemia: review of the literature. Clin Infect Dis 1994; 19: 42–7PubMedCrossRef
84.
Cross JT, Schutze GE, Jacobs RF. Treatment of tularemia with gentamicin in pediatric patients. Pediatr Infect Dis J 1995; 14: 151–2PubMedCrossRef
85.
Johansson A, Berglund L, Sjostedt A, et al. Ciprofloxacin for treatment of tularemia [letter]. Clin Infect Dis 2001; 33: 267–8PubMedCrossRef
86.
Johansson A, Berglund L, Gothefors L, et al. Ciprofloxacin for treatment of tularemia in children. Pediatr Infect Dis J 2000; 19: 449–53PubMedCrossRef
87.
Limaye AP, Hooper CJ. Treatment of tularemia with fluoroquinolones: two cases and review. Clin Infect Dis 1999; 29: 922–4PubMedCrossRef
88.
American Academy of Pediatrics. Fluroquinolones. In: Pickering LK, editor. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2003: 693–4
89.
Krause PJ, Lepore T, Sikand VK, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 2000; 343: 1454–8PubMedCrossRef
90.
Raoult D, Soulayrol L, Toga B, et al. Babesiosis, pentamidine, and cotrimoxazole [letter]. Ann Intern Med 1987; 107: 944PubMed
91.
Fisher-Hoch SP, Khan JK, Rehman S, et al. Crimean-Congo hemorrhagic fever treated with oral ribavirin. Lancet 1995; 346: 472–5PubMedCrossRef
92.
Van de Wal BW, Joubert JR, Van Eeden PJ, et al. A nosocomial outbreak of Crimean-Congo hemorrhagic fever at Tygerberg Hospital: IV. Preventive and prophylactic measures. S Afr Med J 1985; 68: 729–32PubMed
93.
Mardani M, Jahromi MK, Naieni KH, et al. The efficacy of oral ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Iran. Clin Infect Dis 2003; 36: 1613–8PubMedCrossRef
94.
Tsai T. Kyasanur forest disease. In: Strickland GT, editor. Hunter’s tropical medicine. 8th ed. Philadelphia (PA): WB Saunders, 2000: 293–5
95.
Crance JM, Scaramozzino N, Jouan A, et al. Interferon, ribavirin, 6-azauridine and glycyrrhizin: antiviral compounds active against pathogenic flaviviruses. Antiviral Res 2003; 58: 73–9PubMedCrossRef
96.
Smee DF, Sidwell RW, Clark SM, et al. Inhibition of bluetongue and Colorado tick fever orbiviruses by selected antiviral substances. Antimicrob Agents Chemother 1981; 20: 533–8PubMedCrossRef
Metadaten
Titel
Tick-Borne Infections in Children
Epidemiology, Clinical Manifestations, and Optimal Management Strategies
verfasst von
Dr Steven C. Buckingham
Publikationsdatum
01.05.2005
Verlag
Springer International Publishing
Erschienen in
Pediatric Drugs / Ausgabe 3/2005
Print ISSN: 1174-5878
Elektronische ISSN: 1179-2019
DOI
https://doi.org/10.2165/00148581-200507030-00003

Weitere Artikel der Ausgabe 3/2005

Pediatric Drugs 3/2005 Zur Ausgabe

Review Article

Cardiotoxicity of Cancer Chemotherapy

Current Opinion

Facilitating Adherence to Highly Active Antiretroviral Therapy in Children with HIV Infection

Therapy In Practice

Gastroesophageal Reflux Disease in Children with Asthma

Leading Article

Contemporary and Emerging Drug Treatments for Urinary Incontinence in Children

Neu im Fachgebiet Pädiatrie

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise