To evaluate objectively clinical efficacy, safety and usefulness of cefuroxime axetil (CXM-AX) in acute dental infections (periodontitis, pericoronitis and gnathitis), we carried out a comparison study using cefaclor (CCL) as the control. Both drugs were orally given after meals in a dose level of 250 mg (potency) t.i.d. for 3-7 days.
1. Clinical efficacy rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 82.5% (104/126) in the CCL group according to the assessment by physicians in charge, and 89.6% (112/125) and 83.3% (105/126), respectively, according to the assessment based on scores.No significant difference was found between the 2 treatment groups.
In clinical efficacy (assessment by score) classified by background factors, efficacy rate in the CXM-AX group (90.6%, 58/64) was significantly higher (P < 0.05) than that in the CCL group (75.0%, 48/64) in cases receiving no surgical treatment on the first day of drug administration. Other background factors than the above (no surgical treatment) factor or scores on the first day of drug administration, however, did not appear to influence clinical efficacies of 2 treatment groups.
2. As for the bacteriological response in all the treated cases, elimination rate in the CXM-AX group was 73.7% (28/38) and that in the CCL group, 78.3% (36/46), without significant difference between the 2 groups.
3. Regarding the safety, no significant difference was found between the 2 treatment groups. Adverse reactions were observed in 1 out of 128 cases (0.8%) in the CXM-AX group and 6 out of 132 cases (4.5%) in the CCL group. Abnormal laboratory test values were noted in 8 out of 86 cases (9.3%) in the CXM-AX group and 5 out of 91 cases (5.5%) in the CCL group. None of these differences between 2 treatment groups was statistically significant.
4. Usefulness rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 81.7% (103/126) in the CCL group, thus significant difference was observed between the 2 groups.
From the above results, CXM-AX is considered to be a useful drug like CCL in the treatment of acute dental infections.

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One hundred four children with infection accompanying hematologic disorders and solid tumors were treated with aztreonam (AZT)(120-150mg/kg), either alone or in combination with one of the fbllowing drugs;cefmetazole (CMZ)(120-150mg/kg), piperacillin (PIPC)(120-150mg/kg), or amikacin (AMK)(5-10mg/kg).The overall emcacy rate was69.2%.Efficacy rates by regimen were as follows: AZT alone was 63.2%, AZT plus CMZ was 73.6%, AZT plus PIPC was 74.1% and AZT plus AMK was 20.0%. Efficacy rates in different types of infections were 53.2 % for sepsis and suspected sepsis, 78.9% for pneumonia and respiratory tract infection, 93.1% for fever of undetermined origin and 55.6% for other infections. The efficacy rate was 71.3% in 94 patients in whom causative organisms were not identified and 50.0% in 10 patients in whom causative organisms were identified.
Most of infections in which causative organisms were identified were caused by Gram-negative pathogens. The response rate among infections caused by Gram-negative bacilli was 50.0%. A combination of AZT and CMZ or PIPC was effective in 3 (100.0 %) out of 3 patients in whom Escherichia coli was the causative organism. Efficacies classified according to different neutrophil counts were59.3%for<100/μl, 78.6%for101-500/μland82.4%fbr>501/μl.No significant adverse reactions were observed.
These results indicated that combination of AZT and 2nd generation cephalosporins or penicillins were well tolerated and effective for infections complicated with accompanying hematologic disorders and solid tumors.

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The efficacy and the safety of an antibiotic in cephamycin group, cefbuperazone (CBPZ), were investigated in 93 patients with severe infections complicated with hematological disorders.
The efficacy evaluation was made in 85 cases with underlying hematological disorders including 49 cases (57.6%) of leukemia and 18 cases (21.2%) of malignant lymphoma. The overall efficacy rate was 50.6% of the 85 evaluable cases. The clinical efficacy rate for sepsis and suspected sepsis was 53.4%.
The most frequently used group of antibiotics for combination therapy was aminoglycosides in 37 cases, in which an efficacy rate of 62.2%, a higher rate than the efficacy rate of 48.5% for all the combination therapy cases, was obtained. In 16 cases in which penicillins were used as combination drug, the efficacy rate obtained was low, 31.3%.
Efficacy rates obtained for cases with different neutrophil counts at the start of therapies were as follows: 52.2% in 23 cases with neutrophil counts below 100 /mm³, 46.2% in 13 cases with neutrophil counts between 100 and 499 /mm³ and 51.3% in 39 cases with neutrophil counts equal to or above 500 /mm³, thus no significant differences in efficacy rates were observed for patients with different neutrophil counts.
These results appear to suggest that CBPZ, alone or in combination with other antibiotic such as aminoglycosides, may be quite useful in the treatment of severe infections in patients with hematological disorders.

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Sixty-eight patients with severe infections associated with hematopoietic disorders were treatedwith imipenem/cilastatin sodium (IPM/CS) and the efficacy and safety of this drug were evaluated.
1. Fifty-nine patients were evaluable for the efficacy. Clinical efficacies were excellent in 10 patients, good in 24, fair in 11 and poor in 14, and the overall efficacy rate was 57.6%.
2. The clinical efficacy rates were 62% against septicemia and suspected septicemia, 40% against pneumonia and 100% against urinary tract infection (1 case).
3. The clinical efficacy rates when these patients were grouped according to numbers of neutrophils after treatment were: less than 100/mm³; 44.4%, 101-500/mm³; 58.3% and over 501/mm³; 60.5%. The efficacy rate was particularly excellent, 60.0%, for patients with neutrophil counts were less than 100/mm³ both before and after treatment.
4. Sixty-eight patients were evaluable for the safety. Side effects were observbed in 5 patients and abnormal laboratory test values were observed in 5 patients.

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In vitro interactions between carumonam (CRMN) and 8 other antibiotics were studied usingthe agar dilution checkerboard technique against 88 clinical isolates ofEscherichia coli, Proteus vulgaris, Serratia marcescens andPseudomonas aeruginosa. Combinations of CRMN with 8 other antibiotics were generally additive or indifferent. Synergism was found against S. marcescens or P.aeruginosa with CRMN plus fosfomycin, gentamicin (GM) or dibekacin. Antagonism was not observed with CRMN plus any of the 8 other antibiotics tested. In a phase-contrast microscopic study, the synergism of CRMN in combination with GM were confirmed againstP. aeruginosa 15846. CRMN in combination with GM demonstrated ain vivo synergy against experimental urinary tract infection caused by P. aeruginosa 15846 in mice.
We think that combinations of several antibiotics with CRMN should be appropriate for initial therapy of infections because no antagonism appeared to occur with other antibiotic agents.

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To find the optimum dose of cefetamet pivoxil (CEMT-PI, Ro 15-8075), a new oral cephem, in the treatment of complicated urinary tract infections, we performed a randomized trial using cefaclor (CCL) as the control drug.
The subjects were patients with complicated urinary tract infections associated with underlying urinary tract diseases. Patients with indwelling catheter were excluded from the analysis, as were patients with infection due to Pseudomonas aeruginosa.
Patients were treated with 250 mg of CEMT-PI (CEMT-PI-L) 2 times a day, 500 mg of CEMT-PI (CEMT-PI-H) 2 times a day or 500 mg of CCL 3 times a day for 7 days. The overall clinical efficacy was evaluated on the basis of the criteria proposed by the Japanese UTI Committee. Of the 103 patients evaluated for clinical efficacy, 36 patients received CEMT-PI-L, 37 patients received CEMT-PI-H and 30 patients received CCL. No significant difference in background characteristics was observed among the three treatment groups.
The overall clinical efficacies at day 3 judgement were 67.9% in 28 patients treated with CEMT-PI-L, 60.0% in 30 patients treated with CEMT-PI-H and 72.0% in 25 patients treated with CCL, with no statistically significant difference. Those at day 7 judgement was 63.6% in 33 patients treated with CEMT-PI-L, 66.7% in 36 patients treated with CEMT-PI-H and 72.4% in 29 patients treated with CCL, with no statistically significant difference.
The bacteriological eradication rates at day 3 judgement were 79.5% of 39 strains in the CEMT-PI-L group, 73.2% of 41 strains in the CEMT-PI-H group and 84.4% of 32 strains in the CCL group, with no statistically significant difference. Those at day 7 judgement was 78.7% of 47 stains in the CEMT-PI-L group, 85.5% of 55 strains in the CEMT-PI-H group and 94.9% of 39 strains in the CCL group, with no statistically significant difference.
The overall clinical efficacy and bacteriological eradication rate at day 7 judgement for CEMT-PI-H were higher than those for CEMT-PI-L. Clinical adverse reactions were observed in one patient in each of the 3 groups, but no statistically significant difference was found.
We have concluded that the optimum daily dose of CEMT-PI in the treatment of complicated urinary tract infection is 1,000 mg.

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Macrolide (ML) susceptibilities of clinically isolated bacteria obtained freshly during 1989 were determined and year to year differences in ML-resistances of the clinical isolates in our laboratory were examined with epidemiological consideration in mind.
1. The distribution of minimum inhibitory concentrations (MICs) of MLs against isolates of Staphylococcus aureus showed 2 peaks, one peak representing S. aureus isolates susceptible to MLs and the other peak representing those resistant to MLs. Proportions of resistant isolates to various MLs were 36% to erythromycin, 24% each to kitasarnycin, josamycin, midecamycin and midecamycin acetate. MICs of rokitamycin (RKM), however, distributed themselves into 3 peaks of <0.39μg/ml (76%), 1.56-3.13 μg/ml (12%) and>100 μg/ml (12%). Staphylococcus spp. including Staphylococcus epidermidis showed different resistance characteristics to 14-membered ring MLs and to 16-membered ring MLs. Further, the proportion of resistant organisms to RKM was the smallest among proportions of resistant organisms to various 16-membered ring MLs tested. These differences in proportions of resistant organisms to different MLs may have resulted from differences in resistance induction activities of different MLs.
The above described ratios of resistant organisms to MLs among S. aureus did not vary since 1975 among clinical isolates tested in our laboratory.
2. Four per cent (4%) of Streptococcus pyogenes isolates were MLs resistant, and 18% of Streptococcus pneumoniae isolates were resistant to MLs. Among the isolates tested in our laboratory since 1985, resistant isolates of S. pyogenes are clearly decreasing and those of S. pneumoniae seem to be increasing.
3. Because resistances to MLs of Gram-positive bacteria are inducible, we have discussed the importance of selecting appropriate drugs with no or weak inducibility when MLs are used clinically.

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