各種感染性腸疾患特に細菌性赤痢に対するKDM, ABPC併用療法

抄録

Following the remarkable success of KM-AB. PC combination shown by Takahashi in the treatment of resistant (to usual antibiotics) bacillary dysentery, the authors would like to present in this paper another work by the use of Kanendomycin-AB. PC combination in dysenteric diseases putting main emphasis upon bacillary dysentery. This is in line with our arguing point that combination of poorly and readily absorbable antibiotics from the intestine can be regarded as the best of all medication, methods now available in this field. Kanendomycin (KDM), regarded as poorly absorbable antibiotic, is said to be equal to or sometimes superior over KM in antimicrobial activity in single use except for tuberculosis bacilli. The great expectation to this combination was to be allowed from the theoretical viewpoint. This expectation has not been betrayed.
Case and method were:
Cases were 60 of bacillary dysentery (19 of bacilli-positive clinical cases, 16 of bacilli-positive nonmanifested, cases, 25 of bacilli-negative but rectoscopically convincing cases), 13 of salmonellosis (7 of bacilli- positive, 6 of bacilli-positive but not manifested cases), 3 of pathogenic coli infections and 2 of staphy lococcus-isolated diarrheal cases, a total being 78 in number.
In adults, the dosis was total 2g (KDM 1g and AB. PC 1g) divided into as 4 times a day; in infants, 1/2 of adult dosis was a rule. Medication time was 5 days except 2-4 weeks for salmonella carriers.
Strains and resistant patterns were:
All of isolated shigellae were 35, 21 Sonne and 14 Flexner, almost all of which were multiple (CP, TC, SM, SA) resistant but highly sensitive to KDM and AB. PC, respectively. All 13 salmonellae were also highly sensitive to KDM and AB. PC, but different from the shigellae, mostly resistant only to SM and SA. One pathogenic coli was sensitive to KDM and AB. PC, and resistant to TC and SM.
The results of clinical applications were:
Effects of the medication were viewed from stool frequency and appearance, eradicating effects to causatives, and rectoscopic mucus appearance. The effects were compared with those of singly-used-, KDM (2g daily) and singly-used AB. PC (2g daily).
Recovery of stool frequency and appearance in bacillary dysentery was much the same between thecombination and the single use, about 80% being normalized within either 3 or 5 days in the both.
Bacilli eradicating effects were best in the case of the combination (88.6% were turned negative within 3 days), followed by AB. PC (81.6%) and KDM (77.8%). Discharge rate was also lowest in the combination (redischarge cases plus continuingly discharge cases over 6 days were 5.7%), followed by AB. PC (10.6%) and KDM (29.6%).
Rectoscopic recovery rate was best in the case of the combination (cases in which no ulcers remained at the end of 3rd week of illness were 84.4%), followed by KDM (78.6%) and AB. PC (70.0%).
Through these experiments an impression was obtained that the dosis to infants set for by the authors was somewhat too small. It has to be studied further.
Although relatively good effects were obtained in the case of salmonellosis and pathogenic coli infections, decisive comparison had to be reserved because of the scarcity of case numbers. At any rate, 5-day medication was not enough for these diseases.