Efficacy and safety of cefoxitin in the treatment of chronic respiratory tract infections were compared with the respective findings of cefazolin by a well controlled comparative study. Cefoxitin (t. i. d.) and cefazolin (b.i.d.) were given at a dose of 2 g intravenously (either by one shot or drip infusion) for 14 days.
1. Patients subject to analysis: Of the 95 patients (cefoxitin group 47, cefazolin group 48) recruited in this trial, 89 patients (cefoxitin group 44, cefazolin group 45) were adopted by the committee members as eligible for evaluation of clinical and bacteriological efficacy as well as utility. Side effects of these drugs were evaluated in all of the above 95 patients. It was ascertained statisitically that the backgrounds of patients in the cefoxitin group and the cefazolin group were almost homogeneous.
2. Clinical efficacy: The number of patients observed with excellent efficacy in the cefoxitin group was larger than that in the cefazolin gorup, and the cefoxitin group was significantly superior to the cefazolin group in the overall efficacy (P<0.05); of the 44 patients treated with cefoxitin, ‘excellent’ in 16, ‘good’ in 20 ‘fair’ in 7 and ‘poor’ in 1 (efficacy rate 82%), and of the 45 patients treated with cefazolin, ‘excellent’ in 9, ‘good’ in 20, ‘fair’ in 11 and ‘poor’ in 5 (efficacy rate 64%). Especially, the cefoxitin group was superior to the cefazolin group in the efficacy for the patients with pulmonary infections, those with more than 2 underlying diseases, those with infections due to Gram negative rods, and others.
3. Degree of symptomatic improvement: The cefoxitin group was significantly superior to the cefazolin group in the degree of improvement in the property of sputum (on the 7 th day of the treatment), the colour of sputum (on the 3 rd day of the treatment), and the chest pain (on the 7 th day of the treatment)(P<0.05).
4. Bacteriological efficacy: The inhibition rate in the cefoxitin group was higher than that in the cefazolin group, but no significant difference was found between the cefoxitin group and the cefazolin group in their efficacy; of the 44 patients treated with cefoxitin, ‘eliminated’ in 24 ‘suppressed’ in 14, ‘unchanged’ in 5 and ‘replaced’ in 1 (inhibition rate 86%), and of the 45 patients treated with cefazolin, ‘eliminated’ in 21, ‘suppressed’ in 11, ‘unchanged’ in 11 and ‘replaced’ in 2 (inhibition rate 71%).
5. Side effects: Side effects including abnormal laboratory nnaings aue to tne meamation were observed in 9 patients (19%) of the 47 treated with cefoxitin and in 7 patients (15%) of the 48 treated with cefazolin, and there was no significant difference between the cefoxitin group and the cefazolin group in these incidences.
6. Utility: The utility rate in the cefoxitin group was higher than that in the cefazolin group, but no significant difference was found between the cefoxitin group and the cefazolin group in their utility; of the 44 patients treated with cefoxitin, ‘markedly useful’ in 15, ‘moderately useful’ in 18, ‘slightly useful’ in 9 and ‘useless’ in 2 (utility rate 75%), and of the 45 patients treated with cefa. solin, ‘markedly useful’ in 10, ‘moderately useful’ in 19, ‘slightly useful’ in 11, ‘useless’ in 3 and ‘markedly harmful’ in 2 (utility rate 64%).
The results stated in the above suggest that cefoxitin is a useful antibiotic for the treatment of chronic respiratory tract infections.

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The effects of pyomelanin, a brown pigment produced by Pseudomonas aeruginosa, on antibacterial activity of various antibiotics to several bacteria were studied and compared with those of melanin from Stre ptomyces and of human hair.
The antibacterial activities of carbenicillin (CBPC) and gentamicin (GM) against P. aeruginosa were lowered by the addition of pyomelanin to the test medium, whereas that of kanamycin (KM) did not cause any reduction in antibacterial activity. The activity of chloramphenical (CP) and tetracycline (TC) was not affected, but that of colistin (CL) was slightly enhanced.
The effects of CBPC, GM and CL on Escherichia coli was enhanced by an addition of pyomelanin, however to d much lesser extent as compared with that of KM. There was no change in activity of CP and TC respectively. The activity of CBPC, GM, KM, CP and TC respectively against Staphylococcus aureus was enhanced by an addition of pyomelanin.
The antibacterial activity of CBPC, GM and KM respectively against P. aeruginosa was lowered with melanin from Streptmyces. But the activity of CBPC against E. coli and S. aureus was enhanced, and that of GM or KM did not cause change.
The antibacterial activity of GM against P. aeruginosa was markedly reduced with melanin of human hair. That of CBPC and KM respectively was slightly affected. The activity of CBPC against E. coli and S. aureus was markedly lowered by melanin of human hair, and that of GM and KM were also found to be reduced.

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Sixty eight cases (21. 6%) of Mycoptasma pneumoniea (Myco. pn.) infections in 315 patients with lower respiratory infections (LRI) who admitted to KawasakiMunicipal Hospital from Apr. 1979 to Aug. 1980 were investigated. Sixty five cases of 68 patients had fever on admission. These 65 patients were devided into following three groups to evaluate the efficacy of intravenous LM therapy; 1. IV. LM group 28 cases, 2. oral EM group 24 cases, 3. other antibiotics group 13 cases. We also compared these three groups retrospectively in several clinical aspects.
In LM group, average days required to get afebrile, to make cough less, for general conditions to improve, and for CRP to become negative were 1. 2, 4.3, 2. 6, and 8. 1 days, respectively. Percentage of patients getting afebrile in LM group by 36 hours after treatment was 100%. Therefore, it is useful to give LM intravenously for the therapeutic diagnosis when Myco. pn. infections are highly suspected.
It is presumed that next epidemic of Myco. pn. may occur in 1983 or 1984 in Japan. We recommend the intravenous administration of LM to inpatients with LRI initially in the epidemic year of Myco. pn.

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Thiamphenicol (TP) was used alone and in combination with lysozyme (Lz) in the treatment of otolaryngological infections such as chronic otitis media, chronic sinusitis and peritonsillar abscess due to nonsporing anaerobes in 88 outpatients.
The results as follows:
1. In vitro susceptibility test; Most of clinical isolates (93/112 strains; 83.0%) were inhibited dy ≤1.56μg/ml.
2. Clinical and bacteriological response; The efficacy rate of TP alone of clinical and bacteriological respones was 68.2% and 69.4%, respectively. The combination of TP plus Lz, however, was significantly more effective, i. e., 86. 4% in clinical and 82. 6% in bacteriological response.
3. Host defense mechanisms; As this study, synergism between TP and Lz was observed in nonspecific host defense mechanism, that is, bactericidal capacity, chemotaxis and C 3 demonstrated significant variability. On the contrary, sufficiently significant difference in immunoglobulin levels could not observed. These results may suggest that the important factor of host defense mechanism is in the reactivation of several factors of non-specific host defense mechanism caused by Lz rather than immunoglobulins. In addition, further evaluation, however, is necessary to determine its efficacy in the treatment of this form.

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In most in vitro tests, antibiotic concentrations remain static whereas in the body drug concentrations rise and fall in a way which varies from drug to drug and with method of administration. Thus the conditions in which antibacterial drugs are tested by conventional in vitro tests are different from those in which urinary bacteria are exposed to drugs in the treatment of cystitis.
In an attempt to minimize these differences between in vitro and in vivo conditions, O'GRADY and his coworkers have introduced an in vitro model of the urinary bladder in which the conditions of exposure of bacteria to antibacterial drugs which exist in the treatment of cystitis are simulated. We have constructed a similar model of the urinary bladder with some modification.
An outline of our bladder model was introduced and the results of preliminary experiments obtained by use of the model were reported. The bladder model must give the useful informations which are necessary in the treatment of cystitis.

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Of a series of studies on the antifungal activities of isoconazole, a newly developed imidazole antimycotic, this paper deals with its in vitro antifungal and antibacterial activity against a variety of pathogenic and non-pathogenic fungi as well as a pathogenic bacteria.
The minimum inhibitory and cidal concentrations of the antimycotic were determined by means of agar dilution method. As a result, it was demonstrated that isoconazole possessed a strong growthinhibitory activity and a relatively marked cidal effect on these groups of fungi and bacteria; in other words this new drug is one of the broad antifungal spectrum antimycotics with a strong antibacterial activity.

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