We determined the in vitro antibacterial activity of imipenem (IPM), a carbapenem antibiotic, against, 340 clinical isolates of 13 species and compared it with that of piperacillin (PIPC), cefotiam (CTM), ceftazidime (CAZ) and gentamicin (GM), and studied the clinical efficacy and safety of intramuscular imipenem/cilastatin sodium (IPM/CS) in patients with complicated urinary tract infections. The following results were obtained:
1. Antibacterial activity:
The minimum inhibitory concentration (MIC) ₉₀. of IPM was lower than that of the other drugs against Enterococcus faecalis (3.13 μg/ml), Escherichia coli (0.39), Citrobacter freundii (0.78), Klebsiella pneumoniae (0.39), Enterobacter cloacae (0.78), Serratia marcescens (3.13), Providencia rettgeri (1.56) and Pseudomonas aeruginosa (12.5). Remarkable differences in MICs against P.aeruginosa and E.faecalis were observed between IPM and the other drugs.
2. Clinical evaluation
The overall clinical efficacy rating was 69.6% and the bacterial eradication rate was 94.4% in 23 out of the 27 patients with urinary tract infections treated with intramuscular IPM/CS who met the criteria proposed by the Japanese UTI Committee. No adverse effects were observed; but an increase in eosinophils and elevation of GOT and GPT were each observed in one patient, and an elevation of BUN in two. These abnormalities were mild and transient.

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The incidence and nature of fever in hematological diseases were examined in inpatients of our hospital from April 1988 to March 1989. Seventy-nine patients with hematological diseases were hospitalized 130 times. Fever exceeding 38°C was noted in 9.8% of the total days and noted in 103 episodes, and infection was suspected in 94.2%. The neutrophil count was less than 500/μl in half of the patients when they became febrile. Infectious organisms were detected in 41.2% of the febrile episodes: Gram-positive bacteria in 61.1%, Gram-negative bacteria in 25.9% and fungi in 13.0%. Sixteen patients died during this period, and the cause of death was infection in 81.3%.

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Levofloxacin (LVFX) is a newly developed antibacterial agent derived from fluorinated quinolone. We carried out laboratory and clinical studies to evaluate its usefulness in respiratory infections. Thein vitro antibacterial activity of LVFX against 240 isolates of 6 major respiratory pathogens was compared with that of other inhibitors of DNA gyrase. The MIC₅₀ and MIC₉₀ at 10⁶ CFU/ml was 0.013μg/ml and 0.025μg/ml againstHaemophilus influenzae(33 strains), 0.78μg/ml and 1.56μg/ml againstStreptococcus pneumoniae(49 strains), 0.05μg/ml and 0.1μg/ml againstBranhamella catarrhalis(39 strains), 1.56μg/ml and 6.25μg/ml againstPseudomonas aeruginosa(48 strains), 1.56μg/ml and 50μg/ml againstStaphylococcus aureus(48 strains), 0.1μg/ml and 0.39μg/ml againstKlebsiella pneumoniae(23 strains). These MICs were the same as or better than the MICs of other inhibitors of DNA gyrase. The maximal concentrations in the sputum were 2.54μg/ml and 0.64μg/ml. The maximal concentrations in the sputum divided by the maximal concentrations in the serum were 51.4% and 54.2%. These results were almost as same as penetration of other inhibitors of DNA gyrase. Eight patients with 10 episodes of respiratory infection were studied for clinical evaluation of LVFX administered orally at a dose of 300mg or 600mg daily for 3-15 days. The causative organisms wereH. influenzae(4 strains), S. pneumoniae(2 strains), B. catarrhalis(3 strains) andP. aeruginosa(2 strains). The therapeutic efficacy was 88.8%. LVFX had higher antibacterial activity againstS. pneumoniae than the other inhibitors of DNA gyrase (ofloxacin, norfloxacin, and enoxacin). From these results we concluded that LVFX is an effective, useful, and safe oral antibacterial agent for the treatment of respiratory infections.

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In order to find an optimal dose of panipenem/betamipron (PAPM/BP), a carbapenem antibiotic, for the treatment of bacterial pneumoia, a comparative study was performed using imipenem/cilastatin sodium (IPM/CS) as a control drug, and the following results were obtained:
PAPM/BP at 1.0 (group L) or 1.5 (group H) g/day in 2-divided doses and IPM/CS at 1.0g/day (group IPM) in 2-divided doses were systemically administered for 14 days.
1) Clinical effects: Excellent efficacy and efficacy rates were respectively evaluated by the committee to be 6.7% (2/30) and 80% (24/30) in group L, 0% (0/24) and 87.5% (21/24) in group H, and 0% (0/19) and 94.7% (18/19) in group IPM, showing no significant differences among the 3 groups.
2) Bacteriological effects: Bacterial eradication rates were determined to be 100% (14/14) in group L. 77.8% (7/9) in group H, and 100% (8/8) in group IPM.
3) Side effects: Incidences were found to be 0% (0/36) in group L, 6.1% (2/33) in group H, and 6.7% (2/30) in group IPM. None of these side effects were serious.
4) Abnormal laboratory test findings: Incidences were calculated to be 28.6% (10/35) in group L, 36.7% (11/30) in group H, and 21.4% (6/28) in group IPM. These abnormal findings were not serious, but the incidence in group H exceeded 30%.
5) Usefulness: Usefulness rates evaluated by the committee were 76.7% (23/30) in group L, 80.0% (20/25) in group H, and 85.0% (17/20) in group IPM, showing no significant differences among the 3 groups.
From these results, 0.5g×2/day was thought to be an optimal clinical dose of PAPM/BP for the treatment of bacterial pneumonia.

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