Human respiratory syncytial virus (RSV) is a major causative agent of respiratory infections. Common cold syndrome caused by RS virus, which is prevalent in winter, occasionally develops into bronchitis, bronchiolitis and pneumonia. In particular, severe RS virus infections in infants with underlying cardiopulmonary diseases and with low-birth weight baby have been a problem. Furthermore, repetitive RS virus infections occur for the entire lifetime, and the relationship between RS virus infections and exacerbation of COPD and bronchial asthma is also indicated mainly in elderly individuals. Various immunomodulatory effects other than antimicrobial activity of macrolides, including clarithromycin, have been reported, and their clinical usefulness is shown mainly in respiratory diseases. This review describes the findings of action of macrolides on RS virus infections.

In November 2004, “Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan” was published ahead of the rest of the world, by Japanese Society of Pediatric Pulmonology/Japanese Society for Pediatric Infectious Diseases, based on the data on causative organisms in the lower respiratory tract. In its 2011 version, classification of the severity of pneumonia was renewed based on the latest information. As a result, many types of pneumonia in children are noe classified as mild or moderate. This means that many patients who might gave conventionally required hospital treatment can now be managed on an outpatient basis. The reason for realization of the wider range of outpatient treatment is the availability of two new oral antimicrobial agents, tebipenem pivoxil and tosufloxation tosilate hydrate, for the treatment of infections in children.

Analysis of data on medical expenses shows a decreased rate of hospitalization due to pneumonia year after launch of these two drugs, suggesting that these drugs gave contributed to wider range of outpatients treatment.

This manuscript discusses the effect of tebipenem pivoxil and tosufloxacin tosilate hydrate in the treatment of pneumonia.

This in vitro study examined the combined effects of double antibacterial drugs against multidrug-resistant Pseudomonas aeruginosa (MDRP). The tested clinical isolates from Hiroshima University Hospital were 40 strains which met the criteria for MDRP, that is, the minimum inhibitory concentration (MIC) was ≧16𝜇g/mL of meropenem, ≧4𝜇g/mL of ciprofloxation and ≧32𝜇g/mL of amikacin. Using the original checkerboard plates for colistin (CL), arbekacin (ABK), aztreonam (AZT), rifampicin (RFP) and piperacillin (PIPC), MIC values were determined for single and double combinations. Based on the MIC values, fractional inhibitory concetration index values were calculated and the combined effects (synergy action or additive action) were evaluated. The three strongest drugs among the tested combinations were i) CL+RFP (synergy, 80.0%; additive, 17.5%), ii) RFP+ABK( synergy, 7.5%; additive, 70.0%) and iii) RFP+AZT (synergy, 5.0%; additive, 77.5%). In these cases, the arithmetic mean MIC value of each drug significantly decreased as follows: i) 1.38𝜇g/mL (alone) and 0.26𝜇g/mL (with RFP) for CL, 19.85𝜇g/mL (alone) and 1.85𝜇g/mL (with CL) for RFP; ii) 19.85𝜇g/mL (alone) and 7.53𝜇g/mL (with ABK) for RFP, 8.87𝜇g/mL (alone) and 2.79𝜇g/mL (with RFP) for ABK; iii) 19.85𝜇g/mL (alone) and 10.15𝜇g/mL (with AZT) for RFP, 28.3𝜇g/mL (alone) and 6.65𝜇g/mL (with RFP) for AZT. Of 40 strains, metallo-beta-lactamase and aminoglycoside 6’-N-acetyltransferase were found in 20 and 37 strains, respectively; however, no significant influence of these factors was observed on the combined effects of i), ii) and iii). The results of this study provide an in vitro rationale for RFP plus CL, ABK or AZT as an effective combination theraphy for MDRP infections, although the results should be verified and compared with other antibacterial drugs in further studies.

Sitafloxacin (STFX, Gracevit^® 50mg, fine granules 10%), an oral quinolone antibacterial agent, was approved additionally for administration at a dose of 100mg/day was performed from December 2011 to May 2013. In total, 1,186 case cards were collected from 226 medical institutions and 1,089 cases were subjected to a safety evaluation and 1,069 were subjected to an efficacy evaluation.

The incidence of adverse drug reactions (ADRs) was 2.11% (23/1,089cases) and no serious ADR’s were observed. The major ADR was diarrhea at 1.10% (12/1,089 cases). Of these 12 cases, 10 cases developed symptoms within 4 days of treatment. All of them, except one case that could not be followed up, either recovered or improved.

Nonsteroidal anti-inflammatory drugs of the phenyl acetate and propionate types, which require caution when coadministered with STFX, were uses concomitantly by 17.6% (192/1,089 cases) of patients but no central nervous system ADRs were observed.

The overall efficacy rate was 96.4% (1,030/1,069 cases) and by types of infections, it was 97.0% (387/399 cases) for respiratory tract infections, 96.7% (353/365 cases) for urinary tract infections, 94.7% (36/38 cases) for gynecological infections, 92.3% (132/143 cases) for otorhinolaryngological infections, 98.4% (122/124 cases) for dental and oral surgical infections. The efficacy rate in every category of site of infections exceeded 90%.

The overall eradication rate was 94.4% (185/196 strains) including Gram-positive bacteria at 95.4% (62/65 strains), Gram-negative bacteria at 92.2% (92/102 strains), anaerobes at 100.0% (11/11 strains) and atypical bacteria at 100.0% (18/18 strains).

In conclusion, this use-results survey confirmed that STFX 100mg/day is an effective administration with no serious problems in its safety profile and efficacy rate of over 90% in every category of site of infection.

Azithromycin (AZM) is one of 15-membered rings macrolide antibiotics with wide spectrum of antimicrobial efficacy for Gram-positive and -negative bacteria and also atypical bacteria. So far, there had been no reports of the prospective studies evaluation efficacy and safety of AZM infusion in patients with mild or moderate community-acquired pneumonia (CAP). This study was conducted to evaluate prospectively the efficacy and safety of AZM in patients with mild or moderate CAP. AZM 500mg was intravenously administered once daily, and the clinical efficacy were evaluated by clinical symptoms, peripheral blood laboratory findings and chest X-rays. Sixty-four patients were firstly registered, and eventually 61 and 62 patients were enrolled for the evaluation of clinical efficacy and safety of AZM, respectively. The efficacy of AZM in 61 patients evaluated was 88.5%. In addition, the efficacies of AZM in each pneumonia severity index by A-DROP system by the Japanese Respiratory Society (JRS) guideline in CAP were 85.2% in mild and 91.2% in moderate. Furthermore, the efficacy of AZM in each differentiation between suspicion of bacterial pneumonia and that of atypical pneumonia by JRS guideline in CAP were 91.7% in suspicion of atypical pneumonia, and its efficacy was high than that of bacterial pneumonia. Nineteen patients (20 cases; 15 with liver dysfunction, 4 with diarrhea, 1 with vascular pain) out of 62 patients were reported to have possible adverse effects of AZM. All of the patients with these adverse effects demonstrated mild dysfunction and continued AZM treatment, and these dysfunction normalized soon after cessation of AZM.

In conclusion, AZM is effective drug for patients with mild or moderate CAP, and we believe that it may be one of effective choice in the treatment of CAP patients who need hospitalization.

Treatment of chronic pulmonary aspergillosis is difficult and frequently is required for prolong period. In outpatients setting, only voriconazole and itraconazole could be used. Since liposomal amphotericin B (L-AMB) demonstrated prolonged half-time, we have investigated the feasibility of L-AMB in outpatient setting. Three cases of chronic pulmonary aspergillosis were treated with intermittent administration of 2.5 mg/kg of L-AMB twice weekly for one month in outpatient settings. Improve of symptoms was attained in 2 of 3 cases. Improvement of chest images were 2 of 3, improvement of laboratory test were in 2 of 3. Adverse events were only fatigue and short period of fever. No recurrence of pulmonary aspergillosis has been found after treatment. Intermittent administration of L-AMB in outpatient settings could be an option for pulmonary aspergillosis.