Most infections after abdominal operations are endogenous and occur by disseminating bacteria present in the intestinal tract during operation. The risk of developing surgical site infection after abdominal operations is related to the extent of intestinal contamination during operation and to the density and type of bacteria in the intestinal tract. Although antimicrobial prophylactic agents must be active against contaminating bacteria during operation, it should not cover all contaminating bacteria but Staphylococcus aureus except MRSA, Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., Proteus spp. and Bacteroides spp. As the isolation rate and type of bacteria from primary abdominal infections such as perforated perito nitis and biliary tract infection are resemble to those of bacteria contaminating during operations, antimicrobial prophylactic agents could be chosen considering activities against bacteria isolated from primary infections. According to the isolation rates of these bacteria and antibiotic susceptibilities, cefotiam (CTM) is considered to have most strong activities as prophylactic agent for abdominal surgery, followed by cefmetazole (CMZ) and cefazolin (CEZ), in this order. In order to establish the fundamental principle of antimicrobial prophylaxis in surgery, these results should be evaluated by clinical prospective randomized studies in the near feature.

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The usefulness of switch therapy, from injection to oral medicine, for the treatment of peritonitis was evaluated. Thirty-five patients, who agreed to enroll the study, were randomly assigned to four treatment groups; one group treated with carbapenem antibacterial agent alone and three groups treated with switch therapy, in which injectable quinolone was switched to oral quinolone. For the intravenous administration group, if the patient showed the tendency of improvement by the third day, the intravenous injection was continued. However, if the patient did not show any improvement, the medication was changed to other medicine. For the switch therapy group, if the body temperature dropped to 37.5°C or lower for at least 8 hours and if blood findings and clinical findings showed the tendency of improvement by the fourth day, the medication was switched to oral medicine.
There was no difference in therapeutic effects among treatment groups. However, both duration of hospitalization and total medical costs were significantly reduced in the switch therapy groups comparing to those in the intravenous administration group. The results of this study showed that the switch therapy, from injection to oral medicine, was one of useful treatments in treating peritonitis.

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Bacteriai solatedf rom2 5 caseso f perforationp eritonitisa nd its antimicrobiaslu sceptibilitiews eres tudied. Oneh undreda nd forty-sixs trainsi ncluding3 6 strainso f aerobicb acteria, 1 07s trainso f anaerobicb acteriaa nd 3 strainso f yeastw erei solatedf romi ntra-peritoneaflu ido btaineda t operationA. monga erobicb acteria, E ntero-bacteriaceae was isolated from 13 cases (52%) out of all, and followed by those of Enterococcus spp.(24%), Pseudomonas aeruginosa (20%), in this order. Among non-spore forming anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group (64%) was highest, followed by Fusobacterium spp.(40%), Prevotella spp./Porphyromonas spp.(32%) and Bilophila wadsworthia (28%), in this order. The isolation rate of non-spore forming anaerobic Gram-positive bacteria was 60%, and that of Clostridium spp. was 24%. Even by the recent advanced methods, there were 17 strains of anaerobic bacteria, which were not identified by phenotypic-identification levels. Carbapenems and β-lactams plus β-lactamase inhibitors have strong antimicrobial activities against both aerobic and anaerobic bacteria. Although metronidazole and minocycline have strong activities against anaerobic bacteria, there were many strains highly resistant to clindamycin.

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To evaluate the efficacy and safety of CLAVAMOX® dry syrup (potassium clavulanate/amoxicillin) in children with otitis media, we conducted a postmarketing surveillance from February to September 2006. The analysis was made on the basis of 470 survey sheets collected from 127 medical institutions, of which we investigated 455 cases for safety, and 433 cases for efficacy.
The efficacy was 95.2% in the 433 subjects eligible for the efficacy analysis. The clinical improvement rates for major symptoms (otalgia, otorrhea, flare reaction of drum membrane and fever) were 95% or more.The efficacies for the three major offending bacteria of otitis media (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) were between 94.6% and 100%. The efficacies for penicillin-resistant Streptococcus pneumoniae (PRSP) and penicillin intermediate resistant Streptococcus pneumoniae (PISP) were 95% or more.
Adverse drug reactions (ADRs) were reported in 106 (23.3%) of the 455 subjects eligible for safety analysis. The major ADRs were diarrhea, of which incident was 22.6% (103 of 455). TheseADRs were observed at a higher rate in younger age patients.
Most of the diarrhea cases were non-serious, reversible. on discontinuation or continuation of the drug. No clinically important serious diarrhea cases such as pseudomembranous colitis or dehydration were observed.
Our surveillance results demonstrated that CLAVAMOX® dry syrup had excellent efficacy and clinically manageable safety in children with otitis media. These findings indicated that this medicine was clinically-useful in children with otitis media.

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