腸, パラチフスに対するSulfamethoxazole-Trimethoprim合剤の臨床的および細菌学的検討

抄録

Twenty three cases of patients of typhoid and paratyphoid were treated with sulfamethoxazoletrimethoprim (SMX-TMP) combination product (SMX 400mg and TMP 80mg per tablet) to assess its clinical and bacteriological efficacy. The drug sensitivity of isolated strains of Salmonellae was also studied.
Nineteen cases of manifested patients with enteric feven and 4 carriers of Salmonella typhi were admitted to the department of communicable diseases, Kyoto City Hospital during the period from Sept. 1975 to Aug. 1976.
In all patients in acute stage (2 children, 17 adults), SMX-TMP was administered in dosis of 10mg trimethoprim per kilogram body weight daily in two divided doses with maximum of 640mg daily before complete defervescence, whereupon the dosis was reduced to maintenance dosis in a half cases. SMX-TMP therapy was terminated about 10 days after defervescence.
Among 19 cases of typhoid fever and paratyphoid fever at acute stage, 18 responsed to the therapy, the mean period to defervescence being 4.1 days.
Relapse of typhoid fever occurred in a patient 18 days after cessation of the drug therapy. The relapse was successfully controlled with chloramphenicol. In 4 cases, trasient redischarge of the organism in stool occurred after the therapy.
The therapy proved effective in removing the organism in 3 of 4 carriers of Salmonella typhi. Two cases were cured after the operation upon cholelithiasis after the clinical course of unsuccessful elimination of the causatives.
Strains isolated from patients, consisting of 20 strains of Salmonella typhi, 3 strains of Salmonella paratyphi, were tested in vitro to assess their susceptibility to SMX, TMP and SMX-TMP combination (mixed at a ratio 20: 1), respectively
The MIC of SMX, TMP and SMX-TMP combination in Mueller-Hinton agar with 7.5% lysed horse blood for Salmonella typhi ranged from 12.5μg/ml to 6.25μg/ml, 0.1-0.05μg/ml and 0.78-0.2μg/ml, respectively. Three strains of Salmonella paratyphi were inhibited by 25μg/ml of SMX, by 0.39-0.1μg/ml of TMP and by 1.56-0.78μg/ml of SMX-TM, respectively.
No adverse effects such as gastrointestinal disturbance, skin eruption and hematological disorder were noted throughout the series.