The 2, 793 strains of Pseudomonas aeruginosa isolated from clinical materials in our laboratory during a four year period from 1994 through 1997 were examined to study their susceptibility to eleven drugs. As a rule, the criteria of resistance to each drug used in this study followed those of NCCLS. The resistance rates for tobramycin (10.1%) and ceftazidime (10.9%) were the lowest among piperacillin, ceftazidime, cefsulodin, imipenem, aztreonam, gentamicin, tobramycin, amikacin, isepamicin, fosfomycin and ofloxacin. The 181 strains of P. aeruginosa isolated in 1997 were examined to study their susceptibility to eight drugs. The resistance rates for meropenem (13.2%) and tobramycin (13.8%) were the lowest among ceftazidime, cefpirome, cefepime, cefozopran, imipenem, meropenem, panipenem and tobramycin. The combinations of meropenem plus tobramycin, cefozopran plus tobramycin, and ceftazidime plus tobramycin showed marked bactericidal effects against colonies of the selected strains of P. aeruginosa tested. Of these combinations, meropenem plus tobramycin showed the greatest bactericidal effect. By means of the microtiter broth dilution checkerboard method, combinations of ceftazidime plus tobramycin, meropenem plus tobramycin, and cefozopran plus tobramycin were found to be synergistic against 84.3%, 78.6%, and 67.1%, respectively, of the 70 strains of P. aeruginosa tested. No antagonism was observed in this study. These combinations may be useful for P. aeruginosa infections.

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To determine the impact of postoperatively administered flomoxef on normal intestinal flora, we studied in patients who underwent distal gastrectomy. Flomoxef was administered to 7 patients for 4 days. Feces was examined for bacteria before surgery, day 4 of therapy and 1 week after completion of therapy. No change in the anaerobic bacterial count was found after antibiotic administration. Investigation of the major genera of colonic anaerobes revealed that the numbers of Bacteroides spp. were maintained during flomoxef administration. However the number of Bifidobacterium, Veillonella and Clostridium spp. decreased significantly. With regard to the aerobic bacterial count, little change was observed. The numbers of Eecherichia coli were maintained. No significant microbial substitution was detected. Although the number of Enterococcus spp. tended to increase, there were no signigicant changes in the numbers of Staphylococcus spp. and Candida spp. The present study showed that although ecological balance showed a slight change, the function of intestinal flora is mostly maintained by shortterm (4 days) postoperative abministration of flomoxef.

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The oral antifungal drug itraconazole (ITCZ) was administered to documented or suspected systemic fungal infections (SFI) accompanied with hematological diseases. The efficacy and safety of ITCZ and the correlation between plasma ITCZ concentration and its clinical efficacy were evaluated. Safety was evaluated in all 94 patients who received ITCZ, while efficacy was evaluated in 70 (31 documented SFI and 39 suspected SFI). An overall efficacy rate of 66.2%(45/68, excluding 2 patients in whom the efficacy was unevaluable) was obtained with an efficacy rate of 65.5% (19 29) in documented SFI patients and 66.7% (26/39) in suspected SFI patients. Causative fungi were isolated in 28 patients (40%). Candida spp. accounted for 86% of the isolated fungi. The effectiveness obtained in major subgenuses were Candida albicans 8 9 patients, Candida glabrata 2 3 and Candida krusei 2/2, respectively. ITCZ was used due to the failure of previous antifungal drugs in 20 patients. The efficacy rates were 72.2% (13/18) in patients who previously received fluconazole. Adverse reactions and abnormal laboratory findings occurred in one patient (edema of lower limbs and face), and in 14 patients (44 events, 10 of GOT increase, 9 of GPT increase, 7 of LDH increase, and 5 of Al-P increase, etc.), respectively. A relation with ITCZ in these events could not be ruled out. ITCZ was safe in 81.9% (77/94) in the overall safety rating. In conclusion, ITCZ was considered to be safe and effective for SFI patients accompanied with hematological diseases. Good efficacy for fungi other than C. albicans and in patients unresponsive to other antifungal drugs was also demonstrated.

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The clinical efficacy and safety of levofloxacin (LVFX) were evaluated in 19 patients with acute bacterial, chronic bacteirial or chronic non-bacterial prostatitis (ABP, CBP, CNP). We measured urinary cytokines (tumor necrosis factor, TNF-α, interleukin 1β, IL-β, interleukin 6 IL-6, interleukin 8, IL-8) before and after the treatment.LVFX was given to ABP patients at dose of 200-300 mg per day for 14 days and to CBP and CNP at a dose of 100-300 mg per day for 28 days.Efficacy rate for ABP was 6/6 on 7 days by UTI criteria. While that of CBP was 4/9 on 14 day. WBC improved rate of CNP was 3/4 on 14 day. The levels of all cytokines of ABP group and that of IL-1β in CBP group higher than those of control.The levels of TNF-α of ABP after treatment decreased compare with those before treatment significantly.

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Clinical aspects and influence of background factors on the effects of the initial 3 days of drug treatment were studied in 92 patients examined in this department for acute aggravation of chronic airway infections between January 1994 and December 1996. The severity of infection was scored as the aggregate of the scores separately assessed for body temperature, sputum (amount, properties), leukocyte count, and Creactive protein (CRP). The effectiveness of the chemotherapy was assessed from the improvement rates measured at the start of administration, in the infection severity score (ISS), again at the third day and at the termination of treatment (the three-day and final improvement rates), and the early achievement ratio for the treatment was calculated as the former rate relative to the latter. The mean three-day and final improvement rates in the ISS in all patients were 43 ± 25% and 74 ± 22%, respectively, and resulted in a mean early effectiveness ratio of 57% for the chemotherapy. Chronic bronchitis in the infected patients showed an average three-day improvement rate of 57%, which was significantly better than the 33-43% improvement rates of bronchiectasis, diffuse panbronchiolitis, and old pulmonary tuberculosis. Sixty-nine pathogens were identified (Pseudomonas aeruginosa in 27 cases, Haemophilus influenzae in 14, Streptococcus pneumoniae in 13, Moraxella catarrhalis in 6, and methicillin-sensitive Staphylococcus aureus in 3). In the 42 cases whose pathogen was not Pseudomonas (group A), the mean three-day improvement rate was 48 ± 17% which was better than the 38 ± 22% seen in the Pseudomonas group (group B, 27 cases). The mean three-day improvement rate in the group whose etiologic agent was not identified (group C, 23 cases) was 41 ± 22%. No significant difference was observed in the three-day improvement rates for vital capacity of the lung, percent forced expiratory volume in one second, the arterial oxygen partial pressure;nor in the final improvement rate, or the early achievement ratio.

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The in vitro antibacterial activities of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) against 161 recently isolated strains of methicillin-resistant Staphylococcus aureus (MRSA) were investigated and the following results obtained.The MIC peaks for ABK, VCM and TEIC were 0.39 μg/ml, 0.78, μg/ml and 0.78 μg/ml, respectively.VCM inhibited the growth of all the bacteria tested at 1.56 μg/ml, while ABK and TEIC inhibited growth at 6.25μg/ml.The MIC₉₀ of VCM was 0.78μg/ml, while those of the other two agents against MRSA were almost the same.On the correlation diagram of MIC of ABK and VCM, ABK was superior to VCM 59% of the time, while VCM was superior to ABK 18% of the time.For ABK and TEIC, ABK was superior to TEIC 61% of the time, while TEIC was superior to ABK 12% of the time.For VCM and TEIC, VCM was superior to TEIC 40% of the time, while TEIC was superior to VCM 20% of the time.ABK was stronger than other the two drugs in a comparison of the short term bactericidal actions of the drugs.ABK decreased the viable counts by about 2.5 log and 5 log 6 h after the addition of 2 MIC and 4 MIC, respectively.VCM decreased the viable count by about 3 log 8 h after the addition of 2 MIC or 4 MIC.TEIC only decreased the count by about 1.5 log 8 h after addition.

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