As new antimicrobial agents are developed, their efficacies arc usually evaluated by clinical results accumulated from several centres. In these conditions, it is important to use standardized criteria. Therefore, attempts have been made to establish the standard criteria for evaluating the clinical efficacy of antimicrobial agents in urinary tract infections by the Japanese UTI Committee since 1974. The criteria for acute uncomplicated cystitis were established in 1975, those for complicated UTI in 1975, those for acute and chronic bacterial prostatitis in 1987, and those for gonococcal and nongonococcal urethritis in 1988. In this paper, outline and rationale of these criteria are introduced as well as activities of the Japanese UTI Committee in these 15 years.

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We assessed the antibiotic susceptibility of strains of Staphylococcus aureus clinically isolated in Tsukuba University Hospital from December 1987 through July 1989. During the first 10 months the overall frequency of methicillin-resistant Staphylococcus aureus (MRSA) was 74.2%, but this rose to 80.9% during the second 10 months. A progressive increase in resistance to imipenem and ofloxacin was also observed throughout the period. The increasing predominance of multiple drug resistance among MRSA strains isolated from chronically infected patients was alarming. Patients infected with these highly resistant strains may become potential sources of further nosocomial infection. Among the various antimicrobial agents examined, vancomycin remained the most effective drug for the treatment of infection caused by MRSA.

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We evaluated the efficacy of a susceptibility testing method for azole antifungal agents (miconazole, fluconazole, itraconazole) using a semisolid medium [synthetic amino acid medium, fungal (SAAMF), pH 7.4, plus 0.25% agar noble (Difco)] in 96-well plates. Minimal inhibitory concentrations (MICs) were measured after incubation at 30°C for 48 hours. Seventy-four strains clinically isolated 1989-1990 at Nagasaki University Hospital were tested in this study, with the following results.
1) Correlation between MICs determined in semisolid SAAMF and 99% inhibitory concentration (IC₉₉): good correlation was seen between the MIC method and IC₉₉ in miconazole and fluconazole, their correlation coefficients being 0.95 and 0.93. But the correlation in itraconazole was poor, particularly in Candida albicans. In this strain, 24 h incubation was rather favorable.
2) Antifungal activity against clinical isolates: miconazole had excellent activity against Candida albicans and Candida glabrata. Itraconazole showed superior activity against Candida tropicalis, Candida parapsilosis, Candida krusei and Cryptococcus neoformans.
3) Visual determination of endpoints: so-called trailing endpoints were seen, but they were generally weak. Hence it was not difficult to determine the endpoints.
4) Efficacy of the MIC method: firstly, the MICs could be determined visually. Secondly, the method was so efficient that six isolates could be tested on one plate. Thirdly, it was economical because only very small quantities of media and reagents were required.

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We examined the appropriate conditions for measuring the susceptibility to amphotericin-B (AMPH-B) and flucytosine (5-FC) of Candida species. Yeast morphology agar (YMA, pH 7.0) was used as the testing medium and Sabouraud dextrose agar (SDA, pH 7.0) as control medium. Seventy-six strains clinically isolated from 1989 to 1990 in Nagasaki University Hospital were tested in this study to provide the following results.
1. Appropriate measuring conditions.(1) Inoculum size: 5×10³ CFU in absolute values (or concentration of 1×10⁶CFU/ml using a multipoint inoculator), (2) Incubation temperature: 30°C, (3) Incubation time: 48 hours. These conditions were suitable for cell growth and determination of MIC values.
2. Antifungal activities against clinical isolates. MIC ranges of AMPH-B and 5-FC were 0.1-1.56μg/ml and 0.1-50μg/ml on YMA. Although AMPH-B had excellent activity also on SDA, activity of 5-FC was markedly inhibited on it, as stated in past reports.
3. Reproducibility of MIC values. In triple serial measurement by the method mentioned above, all results agreed within one twofold dilution.
4. Valid Period of ready-to-use susceptibility agar: 14 days for AMPH-B and 28 days for 5-FC under dark conditions at 4°C.
5. Our method was so efficient that twenty-seven strains were treated on one agar plate and visual evaluation of endpoints was easy.

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The penetration of fleroxacin to testis and epididymis was examined in four patients with advanced prostatic cancer. Before bilateral orchiectomy as anti-androgen therapy for prostatic cancer, 300mg of fleroxacin were administered, During orchiectomy a serum samphe was taken. The concentrations in serum, testis and epididymis were determined using he HPLC method. At 4 h after administration, the concentrations in serum, testis and epididymis were 4.36±0.28μg/ml, 7.59±1.13μg/g and 6.71±1.51μg/g. At 6h after administration these were 2.94μg/ml, 13.6±3.39μ/g and 12.3±1.63μg/g. The penetration of fleroxacin to testis and epididymis was good. Eighteen patients with acute epididymitis were treated with fleroxacin at 300 mg once daily for 5 days in principle. According to the attending doctor's evaluation, the efficacy was 89%. In patients with bacterial epididymitis, clinical efficacy was evaluated in terms of improvement in symptoms, pyuria and bacteriuria. The clinical efficacy rete was 90% in ten patients evaluated by these criteria. The only adverse reaction was epigastralgia in one case. This improved without treatment. No abnormal laboratory findings were observed. We conclude that fleroxacin is effective and safe in the treatment of acute epididymitis.

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