We determined the MICs of amoxicillin, clarithromycin, azithromycin and ciprofloxacin for 21 Helicobacter pylori strains by using Mueller Hinton semi-solid agar without CO₂ incubation. Generally, the susceptibility of H. pylori to these antimicrobial agents was measured by the agar dilution method with incubation in 10-15% CO₂ at 37°C. However, the MICs of macrolides in medium at pH 6.0 in CO₂ were 8-16 times higher than those at pH 7.0. H. pylori strains of 1.0×10⁷ CFU were inoculated into 1-ml of quantities semi-solid agar (prepared with Mueller Hinton broth to which 2 g of agar per liter was added) in tubes. The tubes were aerobically incubated at 35°C. The tubes were examined for growth of H. pylori at a depth of 3 mm from the surface of the medium. Variation in the inoculum size did not affect the MICs of the four drugs. MICs of the antimicrobial agents except for ciprofloxacin used for quality control strains of the National Committee for Clinical Laboratory Standerds were within acceptable ranges. The MICs of the four drugs (except the twofold dilution of ciprofloxacin) which were measured for 3 days were within the acceptable range. The use of semi-solid agar for the measurement of MICs will assist clinicians in providing appropriate therapy for infections with H. pylori.

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This study was undertaken to investigate urinary tract infection (UTI) in patients managed by clean intermittent catheterization. The subjects were 29 patients undergoing clean intermittent catheterization. We investigated the prevalence of infection, the causative organisms, individual background factors, and the oral antimicrobial therapy used. The criteria for diagnosis of urinary tract infection included pyuria of 10 white blood cells per high power field and bacteriuria of ≥10⁵ CFU/ml. Student's t-test was employed for statistical analysis of the results. After an average follow-up period of 28.2 months, 23 of the 29 patients (79%) experienced UTI. Pyuria without bacteriuria occurred 0.15 times per month and UTI occurred 0.07 times per month on average. There was a significantly higher prevalence of UTI in patients with urinary incontinence and a history of an indwelling bladder catheter. New quinolone antimicrobial agents were the most common antibiotics used (65.8%). Escherichia coli was the major causative organism and gram-negative bacilli accounted for 52.9%. Early introduction of clean intermittent catheterization, and proper explanation to both the patient and the family may facilitate UTI prevention.

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We have reported that clarithromycin (CAM) treatment extends the survival time of patients with non small cell lung cancer as well as improving various clinical parameters in these patients. In the present study, CAM was administered to 27 patients with primary non-small lung cancer. The levels of the cachexia inducing cytokines interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α), as well as clinical parameters (body weight, total protein, albumin, cholinesterase and hemoglobin), were measured before and after three months of treatment. The results were compared with those of non-CAM treatment patients, those with chronic lower respiratory tract infections and healthy individuals. There were no significant differences in blood levels of IL-6 and TNF-α before CAM treatment between the treatment and non-treament groups. These levels were, however, significantly higher than those of the chronic lower respiratory tract infection patients and healthy individuals. At three months after CAM treatment, the levels of IL-6 and TNF-α had decreased significantly, and body weight, cholinesterase and hemoglobin had increased significantly while no significant changes were observed in the non-CAM treatment group. These results suggest that CAM may slow the progression of cancer cachexia.

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We carried out a randomized study of 100 consecutive patients with unresectable primary lung cancer to ascertain whether clarithromycin (CAM), a 14-membered ring macrolide, can improve outcomes. A total of 95 complete cases had received the prior chemotherapy and/or radiotherapy during admission. They were randomly allocated into two study groups based on out-patient clinic attendance after discharge: the first group of 49 patients was given CAM (400 mg/day. orally), while the second group of 46 patients did not receive CAM. CAM administration was continued for as long as the patients could tolerate the treatment. There was no significant difference in median survival time for small cell lung cancer between the CAM and non-CAM groups. In contrast, CAM treatment significantly increased the median survival time for non-small cell lung cancer patients; the median survival time for the CAM group was 535 days while that for the non-CAM group was 277 days (Wilcoxon P=0.0016, Log-Rank P=0.0012). Further more, CAM is more beneficial in adenocarcinoma than in squamous cell carcinoma. We conclude that long-term CAM treatment for unresectable non-small cell lung cancer is beneficial and that this regimen can also increase the median survival time of patients with advanced disease.

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The present study was designed to objectively evaluate the clinical usefulness of single-dose therapy with levofloxacin (LVFX) against female acute uncomplicated cystitis in comparison to that of 3-day therapy. Furthermore, urine interleukin-8 (IL-8) in these patients was measured by ELISA. Patients with uncomplicated cystitis who fulfilled the criteria proposed by the Japanese UTI Committee were enrolled in the study and received either a single dose of 200 mg LVFX or 100 mg LVFX twice a day for 3 days by the random allotment technique using the envelope method. The number of cases judged as being evaluable based on UTI Drug Efficacy Evaluation Criteria was 22 in each group. No significant difference was observed between the 2 groups with respect to clinical background factors. Both groups showed an overall clinical efficacy of 100% on day 3 or day 7 after administration. Regarding the bacteriological response, the eradication rate was 100% in both groups. The urinary interleukin-8 (IL-8) level before therapy was initially elevated but decreased significantly with LVFX treatment. A significant correlation was noted between the urinary IL-8 level and the white blood cell count in urine prior to treatment. Neither side effects nor recurrences were observed in either group. Therefore, there were no significant differences in the clinical efficacy, side effect or recurrence rates between the two groups. These results suggest that single-dose therapy with 200 mg LVFX is useful for the treatment of female acute uncomplicated cystitis.

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Therapeutic effects of levofloxacin (LVFX) on acute uncomplicated cystitis in females werecomparatively examined on the basis of the Japanese evaluation criteria for the effect of drugs on urinary tract infection (UTI) and general guidelines for the evaluation of new anti-infective drugs for the treatment of UTI established by the Infectious Diseases Society of America. A 100 or 200 mg/day dose of LVFX was administered for 3-5 days to a total of 158 cases in which a diagnosis of acute uncomplicated cystitis, accompanying pyuria with 5 cells/hpf or more and bacteriuria with 10³CFU/ml or more, had been made in the facilities participating in this study from September 1994 to March 1995. Clinical effects of LVFX were evaluated immediately, one week and four weeks after completion of drug administration. The results of overall clinical efficacy immediately after completion of administration were as follows: “excellent” in 71.6% of all cases (106/148 cases); “moderate” in 27.7%(41/148); and “failure” in 0.7%(1/148). The effects revealed no significant differences between either daily doses or the numbers of dosing days. The results of microbiological eradication rate/clinical cure rate, one and four weeks after the completion of administration were 93.9%(77/82)/88.1%(74/84) and 92.9%(52/56)/88.5%(54/61), respectively, indicating a high clinical effect. These rates were analyzed according to the number of dosing days, and the following results were obtained, respectively: 89.1%(41/46)/80.4%(37/46) and 90.0%(27/30)/81.3%(26/32) in the 3-day group; 100%(13/13)/100%(13/13) and 88.9%(8/9)/90%(9/10) in the 4-day group; and 100%(23/23)/96.0%(24/25) and 100%(17/17)/100%(19/19) in the 5-day group. Thus, the cure rates tended to be higher in the 5-day administration group, though there were no statistically significant differences. In addition, when the cases were classified into an “excellent” group and “moderate” group immediately after completion of administration to compare the cure rates in the subsequent weeks between the group, the results still showed no significant differences. In some studies, new quinolones even with single dose therapy have shown remarkably high cure rates against acute uncomplicated cystitis. Five-day administration of the drug may, however, be appropriate considering the long-term results (until the 4th week after treatment) obtained in this study. Further acquisition of data from cases and future discussion from the viewpoint of cost-effectiveness are thus considered to be necessary.

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