A malignant tumor and infection have a close relation which is hard to separate. The differential diagnosis of the infection is necessary even at the time of the diagnosis of the malignant tumor. Controlling infection is another difficulty at the anti-cancer treatment as next step. In this report, the issues concerning the infection with lung cancer, especially febrile neutropenia, was argued.

Pertussis has been prevalent among the infants in summer, however, in recent years, it is increasing also in the adult. The epidemiology in 2010 showed pertussis in the adults dominated over 50%. Although the cough in the adults persists for a long time comparing with the infants, the adult pertussis is easy to be overlooked since the symptom is not typical especially in the adults. Therefore, it might be lead to the outbreak in the community. Pertussis is mainly treated

by macrolides, such as erythromycin (EM) or clarithromycin (CAM) at present.

We retrospectively examined pediatric 83 patients with pneumonia due to Mycoplasma pneumoniae, ranging in age from 6 months to 14 years, treated with tosufloxacin (TFLX) for more than 3 days between October 2010 and December 2011. The TFLX dose was 12 mg/kg/day (maximum 360 mg/day). Seventy-eight of the 83 children treated with this drug showed symptom amelioration, and the response rate to the drug was 94.0%. The remaining 5 patients showed no improvement despite drug administration for 3 to 6 days, and TFLX was switched to minocycline, which relieved symptoms. Forty-six of the 83 were given TFLX as initial treatment, and the remaining 37 not responding to clarithromycin (CAM) and azithromycin (AZM) were also treated with TFLX. This drug was effective in 41(89.1%) of the 46 patients initially treated with TFLX and TFLX was effective in all 37(100%) patients not responding to CAM and AZM. Side effects of TFLX included mild diarrhea, observed in 3 patients, but no patients had joint symptoms or convulsions.

Postmarketing surveillance of levofloxacin (LVFX) has been conducted continuously since 1992. The present survey was performed to investigate in vitro susceptibility of recent clinical isolates in Japan to 30 selected antibacterial agents, focusing on fluoroquinolones (FQs). The common respiratory pathogens Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae continue to show a high susceptibility to FQs. In contrast, widely-prevailing resistance to macrolides was markedly noted among S. pneumoniae and S. pyogenes. Regarding H. influenzae, the prevalence of β-lactamase-negative ampicillin-resistant isolates has been increasing year by year (25.8% in 2002, 40.0% in 2004, 50.1% in 2007, and 57.9% in 2010). Enterobacteriaceae showed high susceptibility to FQs, however, prevalence of LVFX-resistant Escherichia coli, including intermediate resistance, was 29.3%, showing an increase over time. Nevertheless, the increase in the prevalence of LVFX-resistant E. coli isolates has slowed since 2007(8.2% in 2000, 11.8% in 2002, 18.8% in 2004, 26.2% in 2007, and 29.3% in 2010), suggesting the influence of LVFX 500 mg tablets since its approval in 2009. Another Enterobacteriaceae member, Klebsiella pneumoniae, showed low resistance to FQs, in contrast with E. coli. In methicillin-resistant Staphylococcus aureus(MRSA), the percentage of FQ-susceptible isolates was low, at 51.6% for susceptibility to sitafloxacin, and at only around 10% for susceptibility to other FQs. However, methicillin-susceptible S. aureus(MSSA) isolates were highly susceptible to FQs, with the percentage ranging from 88.5% to 99.1%. The prevalence of FQs-resistant isolates in methicillin-resistant coagulase-negative staphylococci was higher than that in methicillin-susceptible coagulase-negative staphylococci, although it was lower than the prevalence of FQ-resistance in MRSA. The prevalence of FQs-resistant Pseudomonas aeruginosa isolates derived from urinary tract infections (UTIs) was 15.4–21.3%, higher than the prevalence of 6.1–12.3% in P. aeruginosa isolates from respiratory tract infections (RTIs). While this trend was consistent with the results of previous surveillance, gradual decreases were noted in the prevalence of FQ-resistant P. aeruginosa isolates derived from UTIs. The prevalence of multidrug-resistant P. aeruginosa was 2.3% among isolates derived from UTIs and 0.3% among isolates from RTIs, a decrease from the results of 2007. Acinetobacter spp. showed high susceptibility to FQs. Imipenem-resistant Acinetobacter baumannii, which is currently an emerging issue, was detected at a prevalence of 2.4% (13 isolates). Neisseria gonorrhoeae showed a high resistance of 81.3–82.5%, to FQs. Ceftriaxone (CTRX) continued to show 100% susceptibility until 2007, but the present survey revealed the advent of resistance to CTRX in some clinical isolates. The result of the present survey indicated that although methicillin-resistant staphylococci, Enterococcus faecium, P. aeruginosa from UTIs, N. gonorrhoeae, and E. coli showed resistance of about 20% or more (19.5–89.2%) against the FQs which have been used clinically for over 17 years, the trends observed were similar to the results of previous surveillance. While FQ resistance has been prevailing in E. coli, E. coli still shows more than 70% susceptibility to FQs. The other bacterial species maintained high susceptibility rates of greater than 80%, against FQs.

Antibiotic levels in serum are commonly used to guide antibiotic therapy. The antibiotic levels in peripheral lymph are a more accurate reflection of the efficacy of antibiotic penetration into the tissues of patients with complicated skin and soft-tissue infections. The pharmacokinetics of arbekacin sulfate (ABK) in peripheral lymph after systemic administration has not been studied.

Four patients (cases 1～4) with skin and soft-tissue infections (average age 74.3 years, range 54 to 85) received 200 mg of ABK intravenously once a day either by slow bolus (5 min.) or by slow infusion (60 min.). The serum concentrations collected 60 min. after the start of ABK infusion (C₆₀) and the peripheral lymph concentrations of ABK were measured. 55 min. after initiation of slow 5-min. bolus (case 1), C₆₀ was 32.15 ȝg/mL. The daily average concentration of ABK in peripheral lymph after slow bolus (case 1) was 14.84 ȝg/mL. The ratio peripheral lymph on daily average/C₆₀ was 0.46. Patients (cases 2, 3 and 4) had been intravenously administered ABK at an infusion time of 60 min. C₆₀(cases 2, 3 and 4) were 14.10, 11.48 and 8.26 ȝg/mL, respectively. The daily average concentration of ABK in peripheral lymph after slow infusion (case 2) was 7.80 ȝg/mL. The average concentrations of ABK in peripheral lymph during the third eight hours since slow infusion (cases 3 and 4) were 0.72 and 2.23 ȝg/mL. The ratio peripheral lymph/C₆₀ was 0.55, 0.06 and 0.27, respectively.

An increase in the serum peak concentration of ABK may lead to considerable elevation of the concentration of ABK in peripheral lymph.