Phlebitis related to antibiotic infusion is one of the most frequent causes of morbidity in the debilitated patients with severe infection.There are a number of causes of infusioninduced phlebitis such as pH of intravenous fluid, needle used, and contamination of venipuncture site.Win used to play an important role, particularly in patients with granulocytopenia receiving intravenous infusion.1, 2) Cephalothin is an effective antibiotic in the treatment of granulocytopenic infection and is widely used currently.When cephalothin was introduced commercially, the frequency of phlebitis was ashigh as 50%.3-8) The main reason was thought to be acidity of the antibiotic solution. The cephalothin solution used currently is neutral in pH, but prevention of phlebitis is still not perfect.In contrast, cephapirin recently developed cephalosporin antibiotic, which resembles cephalothin in the antimicrobial activity and pharmacological properties caused less phlebitis than cephalothin in initial clinical studies. The patientsreceiving chemotherapy for malignant diseases frequently die of infections. A cephalosporin antibiotic is administered intravenously for a prolonged time in the presence of thrombocytopenia, and under such circumstances, other antibiotics such as carbenicillin (CBPC) and aminoglycoside are usually used in combination. The influence of these antibiotics injected through the same vein must be considered, but the possibility of phlebitis due to CBPC and aminoglycoside is negligible.9.10)
In the present clinical study, 24 granulocytopenic patients were treated with the combination of antibiotics, cephapirin-carbenicillin-amikacin and cephalothin-carbenicillin-amikacin. Besides the clinical effect of the antibiotics, the incidence and severity of phlebitis were studied.

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The following results were obtained from the comparison of cefoperazone (CPZ) with cefazolin (CEZ), cephalothin (CET) and cefoxitin (CFX) in respect to their antibacterial action against anaerobic bacteria:
1) CPZ showed an antibacterial spectrum which was comparable to those of the known antibiotics, CEZ, CET and CFX.CPZ was particularly effective against anaerobic Gram-positive bacteria.
2) CPZ showed a distribution of susceptibility against clinically isolated strains which was comparable to those of CEZ, CET and CFX. CPZ was slightly inferior to CFX against B. fragilis and B. thetaiotaomicron, but was somewhat superior to any of CEZ, CET and CFX against anaerobic Grampositive rods and B. distasonis.
3) The susceptibility of B.fragilis and F.necrophorum to CPZ decreased with an increase in the amount of inoculation, while C. perfringens and P. asaccharolyticus did not show any difference in susceptibility with the amount of inoculation.
4) The values of MIC and MBC of CPZ showed good coincidence with each other, thereby testifying its superior bactericidal action.
5) Natural resistant mutants were not obtained.
6) According to the examination of resistance in a test tube, P. variabilis did not show any appreciable increase in resistance, but F. varium increased its resistance rapidly.
7) CPZ was inferior only to CFX in stability against the β-lactamase of B. fragilis. All of CEZ, CET and CMD lacked stability against the β-lactamase of B. fragilis.
8) CPZ was found effective for the treatment of experimental subcutaneous abscess in mice caused by F. necrophorum.

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Clinical trial of cefoperazone (CPZ) for the treatment of whooping cough and whooping cough syndrome was performed and the following results were obtained.
1) In 18 cases suffering from whooping cough, CPZ was given 47-106 mg/kg/day (average 72 mg/kg/day) by intravenous route.The clinical efficacy rates judged by doctors in charge were 44% on the 3rd day, 75% on the 7th day, 86% on the period day.And in these cases, the clinical efficacy rates judged by committee members were 56%, 83% and 86%.
2) In 6 cases diagnosed as whooping cough syndrome, CPZ was given 49-96 mg/kg/day (average 59mg/kg/day) by the same route.The clinical efficacy rates judged by doctors in charge were 67% on the 3rd day, 80% on the 7th day and 75% on the period day.And in these cases, those judged by committee members were 83%, 80% and 100%.
3) In 1 case, Bordetella pertussis was searched and showed 0.012mcg/ml of MIC.It was eliminated on the 1st day after administration.
4) Doctors in charge judged the utility of CPZ for whooping cough.Twelve cases were useful and 6 cases were slightly useful.
5) No side effects were observed except for elevation of GOT and LDH.These results suggest that CPZ might be useful drug against whooping cough.

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In order to evaluate efficacy and safety of L-Keflex (granule form of sustained release cephalexin), a double blind study compairing it with Keflex (capsule of regular cephalexin) was conducted in dental infections.
Evaluable cases in adults for efficacy of the drugs were196consisting of 97 for L-Keflex and 99 for Keflex.Those in children were19 (8for L-Keflex and11for Keflex).
There were no significant differences in background of the patients and severity of the diseases between both groups (L-Keflex and Keflex groups).
The daily doses used in both groups were1,000mg in adults and500mg in children, respectively. The dose was given in two divided doses for L-Keflex group and in four divided doses for Keflex group.

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On a new dry filled doxycycline derivative for intravenous administration, some clinical studies were performed.The results obtained were summarized as follows;
1.Intravenous administration was effective in three cases of pulmonary abscess, in one case of bronchopneumonia, in one case of urinary tract infection complicated to nephrolithiasis, in one case of Mycoplasma pneumonia and in one case of tsutsugamushi disease.
2.In one case of FUO (fever of unknown origin), in one case of non-bacterial meningitis and in one case of ampicillin induced hemorrhagic colitis, from whom Klebsiella oxytoca was isolated in feces, satisfactory clinical course was observed with the drug administration.However, as it was impossible to give any comments for the causative agent of each disease, the effectiveness of the derivative was not necessarily clear.
3.Neither side effects nor abnormal laboratory finding caused by the derivative were noticed in any cases.

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[in Japanese]

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Clinical evaluation of cefmetazole were made in the treatment of bacterial infections in the newborn infants and the following results were obtained.
1) Five infants, 7-58 days of age, received a single intravenous one-shot injection of 22.2-24.5mg/kg dose of cefmetazole, and blood concentrations were determined.The average level was 62.6μg/ml (30minutes), 46.3μg/ml (1hour), 26.8μg/ml (2hours), 8.7μg/ml (4 hours) and 2.4μg/ml (6 hours), and T1/2was87.7minutes.Almost similar values were obtained when the drug was given by a 30-minute drip infusion and sufficiently exceeded the MIC to the bacteria to which cefmetazole was indicated.
2) In two patients, who had been operated for choledochal cyst and received an intravenous drip infusion of the drug, the persistence of the blood concentration was remarkably long, T1/2 being 192 and 222 minutes, respectively.This problem still remains to be elucidated.
3) The following 22 patients were treated with an intravenous one-shot or drip infusion of cefmetazole, i.e., 45.6 to 107.1mg/kg divided in 2-3 doses;14 patients aged 1 to 21 days, 2 aged1to less than 2 months, 3 aged 2 to less than 3 months and 3 aged older than 3 months. However, in purulent meningitis, larger dose was given intravenously 6 times daily.Diseases included sepsis (4 cases), purulent meningitis (3), peritonitis (1), SSS syndrome (3), subcutaneous abscess (2), urinary tract infection (8) and Salmonella enteritis (1), and their causative organisms were E.coli (13strains), K.pneumoniae (1), S.typhimurium (1), S.aureus (6) and group B Streptococcus (1).Overall efficacy rate in 22 cases was 90.9%, i.e., excellent in11, good in9and failure in 2.Two cases of failure were a patient with peritonitis and visceral eventration due to umbilical hernia and a patient with a chromosomal aberration and urinary tract infection caused by E.coli.Reasons for such a treatment failure appeared to reside in host factors.
4) Adverse reactions included each one case of skin rash and diaper rash, 3 cases of eosinophilia and 5 cases of elevation of transaminase levels, all of which were mild and transient.
5) Based on the above results, cefmetazole is considered to be a potent new antibiotic which should be indicated as the first choice drug in the treatment of neonatal bacterial infections.The recommended dosage is as follows: 50mg/kg given intravenously6times daily for bacterial meningitis and 20-25mg/kg intravenously or by a drip infusion 2 to 3 times daily for other infections.

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The distribution of sensitivity to 9, 3-diacetylmidecamycin (MOM) was examined of 10 strains of Staphylococcus aureus isolated from foci in our hospital.
A level of less than 3.13 mcg/ml was seen distributed in the majority of 7 cases, and it could be assumed that MOM would be sufficiently effective against infections by Staphylococci in clinical practice.
In the comparison with other antibiotics popularly used, the sensitivity of the 10 strains to them was comparable to those against MDM, but were slightly inferior to cephalexin (CEX) and lincomycin (LCM), and slightly better than ampicillin (ABPC).
The evaluation of clinical results revealed that, of the 20cases with surgical and superficial infections, 6 and 10 were markedly and moderately effective, respectively, while 3 and 1 were fairly and poorly effective, respectively.It was therefore concluded to be an effective remedy for treatment of surgical and superficial infections in which Gram-positive cocci share the majority of the etiological factors.
Of the side effects, there was none showing symptoms in digestive tracts or abnormalities such as rash, nor was there any patient for whom further administration of the agent had to be suspended due to side effects.
No abnormality was seen in the test results between the premedication and postmedication findings on the hemogram, or hepatic and renal functions.It was therefore conjectured that this agent has a large margin of safety in its application.

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