扁桃炎に対するCeftazidimeの基礎的・臨床的検討

抄録

For objective evaluation of clinical efficacy and safety in lacunar tonsillitis, peritonsillitis and peritonsillar abscess, ceftazidime (CAZ) was examined for distribution of sensitivity of clinical strains, tonsillar tissue transfer, and also its clinical usefulness was examined in a multicentre clinical study using the same protocol. 1. CAZ completely inhibited growth of 53 clinical strains of gram-positive bacteria (27 of which were S. pyogenes) and 21 of gram-negative bacteria (14 were B. catarrhalis) isolated from patients with tonsillitis, at the concentrations not higher than 3.13μg/ml and 0.78μg/ml, respectively. 2. Following the intravenous administration of 1g CAZ, the mean tonsillar tissue level was 17.3μg/g (2.6-36.3μg/g, n=19) at 15-240 minutes. The mean ratio of tissue level to serum level was 40.8% (33.8-61.5%). The tissue level reached its peak at 15-22 minutes after administration and then gradually decreased. At 240 minutes after administration, however, the level was still 2.6μg/g. 3. In the clinical evaluation, 83 patients received CAZ. Clinical effectiveness and usefulness were evaluated in 78 patients, and safety in 80. The dose of CAZ was 1g twice daily in most of the 80 patients in the safety evaluation (65, 81.3%), and the duration of administration was 3 to 5 days in 43 patients, 53.8%. 4. Clinical efficacy rate (‘Excellent’ and ‘Good’) assessed by the Efficacy Assessment Committee was 94.9% (74/78) and that by the doctors in charge was 100%. The percentage of ‘Excellent’ cases was 61.5% in the assessment by the Committee and 67.9% in the doctors' assessment. As for bacteriological response, all the strains isolated before CAZ administration were eliminated, except for those from 3 patients whose response was unknown. 5. No clinical adverse event was observed in any of the 80 cases evaluated. Elevation of serum transaminases (4 cases), increase in eosinophil count (2 cases) and increase in platelet count (1 case) were observed in the laboratory tests, but none of them were serious. In conclusion, CAZ is considered to be highly useful in the treatment of tonsillitis.