慢性中耳炎の細菌の動向およびその局所療法

抄録

1. The present report is concerned with 122 patients (133 ears) with chronic otitis media. These patients visited the Department of Otorhinolaryngology, Osaka City University Medical School and underwent bacteriological examinations. In the first bacteriological examination, the most frequently detected strain was Pseudomonas (in 39 ears), followed by Proteus inconstans (in 37 ears). The prominent increases of these strains attracted our attention. Next to these two strains, Staph. aureus (in 31 ears), Staph. epidermidis (in 31 ears), Proteus mirabilis (in 29 ears) and Corynebacterium (in 19 ears) were also detected in this order of frequency. Analysis of the total bacteriological data from 215 ears including those from ears examined twice or more further clearly disclosed a great increase in Proteus inconstans and a high incidence of fungi.
In cases where otorrhea after the acute phase of chronic otitis media persisted for shorter periods, Staph. aureus took place the other strains.
2. Antibiotic sensitivities of bacteria in the otorrhea from patients with chronic otitis media were tested.
1) Almost all of Staph. aureus were sensitive to cephalosporins, CP, TC, GM, CBPC and SBPC, but 23% of them were resistant against ABPC. EM, SM, KM and LCM were resistant to about 70% of the strains detected.
2) Only few strains of P. mirabilis resisted penicillins, cephalosporins, TC and GM.
3) Strains belonging to P. inconstans were highly sensitive to CBPC and SBPC but GM was resistant in 28% of these strains.
4) Strains belonging to Pseudomonas showed high sensitivities to GM and CL.
3. Colimycin F solution was used in 36 cases of chronic otitis media, and the following results were obtained.
1) This drug was highly effective in those in whom otorrhea after the acute phase of chronic otitis media persisted for shorter periods, while the effect was inferior in those ears accompanied by the otorrhea lasting for longer periods.
2) The efficacies were analyzed by the strains. This drug was effective for Staphylococus and is hopefully utilized for elimination of Pseudomonas. Proteus, on the other hand, did not respond to this drug in many cases. In addition, Colimycin F frequently induced growth of Proteus as a result of microbial substitution.
4. SBPC-Rinderon solution was prepared by adding Rinderon to 5% SBPC saline solution and topically applied in the cases of chronic otitis media. It was effective in 12 out of the 15 cases (80%) without adverse reactions in any case. In some cases, however, Pseudomonas and Candida began to grow due to microbial substitution. Some countermeasures for controlling these growths must be taken when prescribing this drug.