In order to establish useful therapeutic methods in chronic lower respiratory tract infection, we carried out long-term tratment (12-41 months) of erythrymycin (EM) using dosages of 600-1, 200 mg/day. Thirteen cases with diffuse panbronchiolitis (DPB) were the subjects of this study. All patients complained of large amounts of purulent sputum and DOE, and had decreasing of PO₂ levels. Major infections of Haemophilus influenzae and Pseudomonas aeruginosa bacteria were detected by TTA before EM therapy. The clinical responses to treatment were markedly effective (1 case) effective (10 cases) and mildly effective (2 cases). Two cases infected by P. aeruginosa had effective responses to treatment. Improvement of QOL was noted in all cases, and no significant side effects were noted during the long-term treatment. Early intervention with EM treatment was required because the clinical responses were considered less efffective in cases with elevated PCO₂. The causative bacteria of acute exacerbation during EM treatment were mainly H. influenzae or Streptococcus pneumoniae, which easily developed after viral infections of P. aeruginosa or in cases which bacteria can not be detected significant amounts from sputum. In erythromycin- ineffective patients, long-term clarithromycin treatment was found effective. EM therapy for DPB may be discontinued, when the clinical manifestations of disease (especially purulent sputum) disappear, and the diffuse, nodular opacities in chest roentgenogram almost completely resolve. We consider these results indicate that this therapy is a new and useful treatment for chronic lower respiratory tract infections.

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We have developed a kit which simplifies the dispensing of broth into a well. This kit has the following structure. Thus, a broth is poured over the kit surface, extra broth is absorbed by the liquid-absorbent body placed in the bottom of the kit, and the broth is only maintained in the well quantitatively. A sampler kit yielded good results in basic physical performance in terms of the absorbtion time for extra broth and the quantity in the well. A characteristic of this method was simplified dispensing of the broth into the well which contains antibiotics. Furthermore, the tray into which the bacterial liquid is poured and broth dispenser are unnecessary, raising the possibility of reducing the initial cost and decreasing rejection which is necessary for sterilization. We compared the MIC of the standard method with the MIC of the kit for about 121 strains and 15 antibiotics. Our kit was very cost-effective, showing a coefficient of correlation of 0.9938-0.9950 in comparison with a standard method. This suggests that the kit is applicable to antibiotic susceptibility testing.

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In the selection of antibacterial drugs for treating odontogenic infection, we determined the MIC of ampicillin (ABPC), cefaclor (CCL), cefteram (CFTM) and ofloxacin (OFLX) against anaerobic gram-negative rods isolated from the human saliva, and examined these bacteria for β-lactamase production. From the saliva of 41 of 50 volunteers, 77 strains of anaerobic gram-negative rods were isolated. Among them, black-pigmented gram-negative rods including Prevotella melaninogenica and Prevotella intermedia were dominant. The MIC distribution of CCL, CFTM and OFLX against Prevotella, Porphylomonas gingivalis and Bacteroides ureolyticus were wide range and showed two peaks. The breakpoint was decided by MIC distribution and resistant bacteria was determined that growth above breakpoint. The breakpoints of CCL, CFTM and OFLX were 32, 16 and 16μg/ml, respectively. The MIC distribution of ABPC was showed three peaks, the breakpoint was 1μg/ml, the strains thatgrowth at or bellow 16μg/ml were moderate resistant and above 16μg/ml were high resistant. Fusobacterium sp. and unidentified strains were detected on the MIC distribution, similarly. The breakpoint of CCL against Fusobacterium sp. was 16μg/ml and ABPC, CCL, CFTM and OFLX against unidentified strains were 64, 16, 32 and 16μg/ml, respectivery. Total 41 resistant strains were isolated. Type of resistance in these bacteria included one to four drug resistance. Thirty-two strains produced β-lactamase, but the susceptibility of 3 β-lactamase producers to 3 β-lactams was high. One of the 9 OFLX-resistant strains produced β-lactamase, but was not resistant to β-lactams. However, 5 OFLX-resistant strains without β-lactamase production showed resistance to β-lactams. These results suggest that in the choice of antimicrobial agents for treating odontogenic infection, attention must be paid to β-lactam antibiotic-resistant with β-lactamase production or OFLX-resistant anaerobic gram-negative rods.

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Eikenella corrodens is a facultatively anaerobic gram-negative bacillus that is a normal inhabitant of the oral cavity, upper respiratory tract and gastrointestinal tract. Recently, the pathogenic role of this organism has been proven, but pulmonary infection caused by this organism is still uncommon. We report three cases of pulmonary infection, lung abscess, secondary infection of pulmonary bulla with aspergillosis, and empyema, from which E.corrodens was isolated by percutaneous lung aspiration or puncture of pleural effusion. Care should be taken in the diagnosis and treatment of pulmonary infection by E.corrodens since this organism may easily be missed on routine sputum culture, and since this organism exhibits an unusual antimicrobial susceptibility pattern as a pathogen of lung abscess or empyema.

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