In this study, we compared the efficacy, adverse event incidences, and medication compliance of MEIJI^® (T group) with those of Ozex^® (O group) tosufloxacin tosilate fine granules. Tosufloxacin tosilate fine granule was effective in all but one case (32/33) while the time to defervescence was within 2 days of drug administration in both groups (T and O groups, 1.31 and 1.92 days, respectively). The time to cough improvement was within 3 days of drug administration in both groups (T and O groups, 2.27 and 2.64 days, respectively). Adverse events were observed in 7.3% and 14.1% of the T and O groups (6/82 and 10/71), respectively. The medication compliance was good in both groups and, overall, the mean rate of administration of the T and O groups was 93.8% and 97.0%, respectively. The rate of complete administration was 87.8% (72/82) and 91.5% (65/71) in the T and O groups, respectively. No significant changes were observed between the two groups in efficacy, adverse event incidences, and medication compliance. Therefore, tosufloxacin tosilate fine granule 15% for pediatrics (MEIJI^®) may be equivalent to tosufloxacin tosilate hydrate 15% for pediatrics (Ozex^®) in efficacy, adverse event incidences, and medication compliance.

We investigated the susceptibility to antibacterial agents of 175 strains of Haemophilus influenzae isolated at medical facilities in Gifu, Aichi, Toyama and Fukui prefectures between 2014 and 2015. Those strains were also examined for the mutations of ftsI coding for penicillin-binding protein 3, presence of bla TEM-1, serotype and β-lactamase producing ability.

Among the 175 strains, 93 strains (53.1%) were isolated from adult patients and 82 strains (46.9%) were isolated from pediatric patients, and 86 strains (49.1%) were derived from sputum, 57 strains (32.6%) were derived from the pharynx and 21 strains (12.0%) were derived from nasal discharge or the nasal cavity. The MIC90s of antibacterial agents against the 175 strains were as follows; 0.0156 µg/mL for tosufloxacin, 0.0313 µg/mL for garenoxacin, levofloxacin and pazufloxacin, 0.0625 µg/mL for moxifloxacin, 0.125 µg/mL for tazobactam/piperacillin, 0.25 µg/mL for ceftriaxone, 0.5 µg/mL for meropenem, minocycline and cefditoren, 1 µg/mL for tebipenem and cefteram, 2 µg/mL for cefotaxime and azithromycin, 4 µg/mL for piperacillin, 8 µg/mL for sulbactam/ampicillin, 16 µg/ mL for amoxicillin, clavulanic acid/amoxicillin (1:2 and 1:14), ampicillin, cefdinir and clarithromycin.

Based on the susceptibility among the 175 strains to antibacterial agents, β-lactamase non- producing ampicillin-susceptible H. influenzae (BLNAS) accounted for 47 strains (26.9%), β-lactamase non-producing ampicillin-intermediately resistant H. influenzae (BLNAI) accounted for 31 strains (17.7%), β-lactamase non-producing ampicillin-resistant H. influenzae (BLNAR) for 72 strains (41.1%), β-lactamase producing ampicillin-resistant H. influenzae (BLPAR) for 17 strains (9.7%) and β-lactamase producing amoxicillin/clavulanic acid-resistant H. influenzae (BLPACR) for 8 strains( 4.6%).

According to PCR-based genotyping, the strains were classified as 29 strains (16.6%) for gBLNAS, 7 strains (4.0%) for gLow-BLNAR, 114 strains (65.1%) for gBLNAR, 13 strains (7.4%) for gBLPAR, 1 strain (0.6%) for gBLPACR-I and 11 strains (6.3%) for gBLPACR-II.

Among the 82 strains isolated from pediatric patients, the most prevalent serotype was non-typeable (79 strains, 96.3%), followed by serotype f (2 strains, 2.4%) and b (1 strain, 1.2%).

In this study, the ratio of H. influenzae type b (Hib) isolated from pediatric patients was decreased compared with the previous study. It was seemed to be affected that Hib was added to routine vaccination from 2013.

Although the susceptibilities to antibacterial agents were not that different to the previous study and the increasing trend of BLNAR was no longer observed, the ratio of BLNAR remains high. We have periodically reported local surveillance of antimicrobial susceptibility of H. influenzae. Moreover, in order to ensure the appropriate antibiotic use, it is important to continue the local surveillance of antimicrobial susceptibility.

Peramivir was administered to 24 pediatric patients younger than 4 months with influenza A virus infection who were hospitalized within 24 hours of disease onset during the period from November 2010 to December 2016, and the clinical efficacy of the drug was retrospectively investigated. Peramivir 10mg/kg/dose was drip-infused intravenously over a period of 15 to 30 minutes. Clinical evaluation was based on fever duration until body temperature decreased to ≤37.5°C after the administration. The number of patients and the time taken for fever resolution after peramivir administration were as follows: 3 patients (12.5%), ≤6 hours; 8 (33.3%), 6–12 hours; and 8 (33.3%), 12–24 hours. A second administration of peramivir was given to 2 of 7 patients in whom fever resolution was not achieved 24 hours after the first administration. Body temperature decreased to the target temperature in all patients within 48 hours of the first drug administration. No adverse events were observed. In 3 patients of 1 month, in whom peramivir was not used because their guardians did not consent to use the drug, fever resolved 59–71 hours after the onset of fever. The result of this study suggests that peramivir is effective for the treatment of influenza even in patients younger than 4 months.

We evaluated the yearly change of in vitro susceptibility to vancomycin (VCM) of clinically isolated Staphylococcus aureus (2,099 strains), Streptococcus pneumoniae (1,038 strains) and Enterococcus spp. (1,736 strains) between 2002 and 2014, and Clostridium difficile (450 strains) between 2006 and 2014. Furthermore, we also surveyed appropriate use of generic VCM products by the yearly sales figures.

The MIC₉₀s of VCM against methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), S. pneumoniae, Enterococcus spp., and C. difficile were 1, 1～2, 0.25～0.5, 2～4 and 0.5～1 μg/mL, respectively. Yearly change of susceptibility to VCM of these isolates was not observed, and it was confirmed that the excellent antimicrobial activity was still maintained. Sales volume of generic VCM products have been increasing gradually from 2002 launched injectable formulation, thus the radical increase was not observed.

Since the explosive increase in usage and the spread of antimicrobial resistant bacteria associated with it in The United States were not observed, it is suggested that the appropriate use of VCM has been performed in Japan.

However, it might be essential to perform the appropriate use continuously not only to prepare for occasional infections of vancomycin-resistant Enterococci and vancomycin-resistant S. aureus which has not been reported yet in Japan, but also to monitor the invasion and the spread of vancomycin-resistant bacteria from overseas.