Bacterial culture of the nasal cavity, throat, and feces was carried out in 40 patients who underwent gastrointestinal surgery. Twenty patients had rectal or colon cancer, 11 had gastric cancer, 5 had esophageal cancer, and 4 had other diseases. Except for 2 patients, none of the patients with esophageal cancer and gastric cancer received preoperative antibiotics. Kanamycin and metronidazole were administered to patients prior to intestinal surgery. Twenty-eight patients received cefazolin as postoperative chemotherapy, 8 patients received flomoxef, 2 received cefotiam, and 2 received cefmetazole. Comparison of cultures obtained before and after surgery showed that isolation of methicillin-resistant Staphylococcus aureus (MRSA) from the nasal cavity and throat increased markedly, from 2 to 8 patients and from 2 to 13 patients, respectively. In 6 patients with more than 10³CFU/ml of bacteria, MRSA was isolated from both the nasal cavity and throat. In these MRSA-positive patients, cultures for MRSA remained positive after removal of the nasogastric tube. In patients in whom methicillin-susceptible S. aureus (MSSA) was isolated from the nasal cavity and throat before surgery, the bacteria were eradicated by postoperative chemotherapy in most cases. Before surgery, gram-negative organisms were isolated from the nasal cavity and throat in only a few patients, but the isolation rates of these bacteria increased significantly following postoperative chemotherapy. In particular, the isolation rates of Klebsiella spp, Enterobacter spp, Pseudomonas spp, and Acinetobacter spp were high. Cultures for these bacteria remained positive after removal of the nasogastric tube. Postoperative these bacteria remained positive after removal of the nasogastric tube. Postoperative infection occurred in 8 patients. In all but 1 patient, the onset was 5 days or more after surgery. The causative bacteria suspected or identified were mainly MRSA and Pseudomonas aeruginosa. It was noted that these bacteria had been isolated from the throat 3 days after surgery. The results of this study suggest that performing bacterial culture (monitoring culture) of the nasal cavity and throat before and after gastrointestinal surgery is useful for the prevention of postoperative infection.

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We used agar-dilution MIC determinations to asses the activity of 39 antibacterial agents against various clinical isolates (16 species, 1, 386 strains), most of which were isolated in 1992 at 18 facilities in Japan. We found that 58.1% of the strains of Staphylococcus aureus were methicillin-resistant S. aureus (MRSA) Vancomycin (VCM) and arbekacin (ABK) proved to have the highest antibacterial activity against these MRSA with an MIC₉₀ of 0.78 and 1.56μg/ml, respectively. Most of the β-lactam antibiotics displayed high antibacterial activity against Streptococcus pneumoniae, especially cefuzonam (CZON), cefpirome (CPR) and the carbapenems, whose MIC₉₀ was less than 0.39μg/ml. The incidence of penicillin-resistant S. pneumoniae was 37.0%. The agents which showed the highest antibacterial activity against Enterococcus faecalis were ampicillin (ABPC), imipenem (IPM) and VCM (MIC₉₀≤3.13μg/ml). Most cephems, carbapenems and quinolones exhibited high antibacterial activity against Escherichia coli and Klebsiella pneumoniae with an MIC₉₀ of less than 3.13μg/ml. Most cephems, carbapenems and quinolones also showed high antibacterial activity against Haemophilus influenzae, with that of ciprofloxacin (CPFX) being especially high with MICK, of 0.013μg/ml. ABPC-resistant H. influenzae accounted for 10.0% of the H. influenzae strains. Carbapenems displayed the highest antibacterial activity against Pseudomonas aeruginosa (MIC₉₀ 6.25 μg/ml). Ceftazidime (CAZ)-resistant P. aeruginosa strains and IPM-resistant P. aeruginosa strains accounted for 29.1% and 8.7% of their groups, respectively, while quinolone-resistant strains represented 16.5-33.0%. Suitable antibiotics for detecting MRSA by agar-dilution MIC determination were oxacillin (MPIPC) and flomoxef (FMOX). mecA-positive strains accounted for 73.4% of Staphylococcus epidermidis strains and the presence of the mecA gene coincided with MPIPC susceptibility.

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To accurately determine the incidence of symptoms of hypersensitivity such as anaphylactic shock and eruption, as well as other serious adverse reactions to cefaclor (CCL), we conducted a nation-wide prospective study. Goals for the numbers of subjects were established according to the region, the institutions and departments of each institution, so that the statistically calculated population size (106, 447) and the results of CCL use would be reflected in these numbers. The investigation period was scheduled by each institution in advance, and patients who visited the institution during the that period and to whom CCL was prescribed were used as subjects. The following results were obtained.
1. CCL was administraered to in 108, 549 patients at 904 institutions throughout Japan, and 108, 276 were actually treated with CCL after thorough questioning as to their history of allergy.
2. Adverse reactions occurred in 0.11% of the subjects (228 of 108, 276 subjects). The incidence of symptoms of hypersensitivity including anaphylactic shock (0.001%; one case) and eruption was 0.103%(112 cases), that of gastrointestinal symptoms 0.95%(103 cases), abnormal hepatic function 0.007%(8 cases) and others 0.011%(12 cases). Most of the adverse reactions observed were mild or moderate, and there were no serious adverse reactions, except for one case of anaphylactic shock.
3. The incidence of adverse reactions was higher in adults than in children, and in women than in men. It was particularly high in women in their 30 s. The incidence was high in palients with underlying diseases and complications, and those with a past history of allergy. It was also high in palients with a past history of allergy to drugs. It was higher after administration of capsules than after that of fine subtilaes, and in patients who were using other drugs concomitantly
4. The improvement rate (effectiveness) was 85.3% and the utility rate was 89.8%. The improvement and utility rates were almost the same regardless of the dosage form.
These observations suggest the importance of inquiry about the past history and family history of allergy prior to the administration of antibiotics such as CCL. A prospective study like the current one is considered useful for appropriate understanding of the incidence of adverse reactions.

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The clinical efficacy, safety and usefulness of biapenem (BIPM), a new carbapenem antibiotic for injection, were evaluated in bacterial pneumonia in a comparative study with imipenem/cilastatin (IPM/CS). Patients were given 600mg (potency) of BIPM or 1, 000mg (potency)/1, 000mg of IPM/CS daily (b.i.d.) for 14 days, and the following results were obtained:
1. A total of 183 cases were enrolled in this study, and 146 cases were evaluated for clinical efficacy. Efficacy rates were 94.8%(73/77) in the BIPM group and 92.8%(64/69) in the IPM/CS group, with no significant difference between the two groups.
2. Bacteriological eradication rates were 90.9%(20/22) in the BIPM group and 93.1%(27/29) in the IPM/CS group, with no significant difference between the two groups.
3. The incidence of adverse reaction was 3.4%(2/89) in the BIPM group and 3.6%(3/83) in the IPM/CS group. There was no significant difference between the two groups. The incidence of abnormal laboratory findings was 29.5%(26/88) in the BIPM group and 25.6%(20/78) in the IPM/CS group. There was no significant difference between the two groups.
4. The usefulness rates were 94.8%(73/77) in the BIPM group and 88.6%(62/70) in the IPM/CS group. There was no significant difference between the two groups.
No significant differences were observed between 600 mg (potency) of BIPM and 1, 000mg (potency)/1, 000mg of IPM/CS daily (b.i.d.) with respect to any of the above parameters. These results indicate that BIPM is useful for the treatment of bacterial pneumonia and lung abscess.

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The clinical efficacy, safety and usefulness of biapenem (BIPM), a new carbapenem antibiotic for injection, were evaluated in chronic respiratory tract infections in a comparative study with imipenem/cilastatin (IPM/CS) Patients were given 600 mg (potency) of BIPM or 1, 000mg (potency)/1000mg of IPM/CS daily (b.i.d.) for 14 days, and the following results were obtained:
1. A total of 203 cases were enrolled in this study, and 185 cases were evaluated for clinical efficacy Efficacy rates were 90.3%(84/93) in the BIPM group and 83.7%(77/92) in the IPM/CS group, with no significant difference between the two groups.
2. Bacteriological eradication rates were 70.9%(39/55) in the BIPM group and 66.7%(34/51) in the IPM/CS group, with no significant difference between the two groups.
3. The incidence of adverse reaction was 2.1%(2/95) in the BIPM group and 4.1%(4/98) in the IPM/CS group. There was no significant difference between the two groups. The incidence of abnormal laboratory findings was 20.9%(19/91) in the BIPM group and 21.1%(19/90) in the IPM/CS group. There was no significant difference between the two groups.
4. The usefulness rates were 90.3%(84/93) in the BIPM group and 81.7%(76/93) in the IPM/CS group. There was no significant difference between the two groups.
No significant differences were observed between 600 mg (potency) of BIPM and 1, 000mg (potency)/1, 000mg of IPM/CS daily (b.i.d.) with respect to any of the above parameters. These results indicate that BIPM is useful for the treatment of chronic respiratory tract infections.

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A comparative study was carried out between one-day therapy with oral ciprofloxacin (CPFX) and three-day therapy with oral cephems (CEPs), for the treatment of acute uncomplicated cystitis. The overall efficacy rate of one-day therapy with CPFX was 85.7%(42/49) and threeday therapy with CEPs was 93.2%(41/49). There was no statistically significant difference between the overall efficacy rates of the two regimens. These results suggest that one-day therapy with oral ciprofloxacin is effective and economical against acute uncomplicated cystitis.

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We evaluated the antibacterial activity and efficacy of carindacillin (CIPC), a synthetic penicillin, in the urological field.
1) Antimicrobial activities: Statistical studies were performed on Psudomonas aeruginosa isolated from patients with urinary tract infection from 1983 to 1991. Antimicrobial activities of new quinolones against these strains were annually reduced both in Muller-Hinton broth (MHB) and in artifical urine (AU). Antimicrobial activities of new quinolones in AU were more reduced than those in MHB, but the antimicrobial activities of CIPC were less reduced in both MHB and AU than those of the new quinolones. It was considered that the antimicrobial activities of the new quinolones were reduced due to low pH and high concentrations of magnesium and calcium in AU.
2) Clinical efficacy: According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 61.9%(13/21). Bacteriologically, 21 of 34 strains (61.8%) isolated were eradicated. The eradication rate for P. aeruginosa was 57.1%(12/21).
3) Side effects: No clinical side effects or abnormal laboratory changes were observed.
Based on the above results, CIPC might be useful in the treatment of urinary tract infection caused by P. aeruginosa.

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