Genital herpes is the leading viral sexually transmitted disease in Japan and its treatment is a great matter of concern. From the pathogenetical viewpoint, there are two types of infection, namely the primary and the recurrent or provoked type, the latter being caused by reactivation of latently infected herpes simplex virus (HSV). In women, 41.5%% of genital herpes has been caused by HSV-1 and the remaining 58.5% by HSV-2. Fifty eight per cent of the acute type, mainly primary infection, was caused by HSV-1 and 42.0% by HSV-2. The recurrence rate within one year after primary infection was 86%% for HSV-2 and 25 for HSV-1 patients. On the other hand 84.3%% of the recurrent type and 87.8% of the provoked type were caused by HSV-2. Although three nucleoside analogs (Acyclovir, Valacylovir, Famciclovir) have been developed for treatment of herpes virus infection, and are currentoly being used in the USA and UK, only acyclovir (ACV) is available for the systemic treatment of genital herpes in Japan. The regimen permitted by social insurance for the treatment of genital herpes is ACV 200 mg orally five times a day for five days. The duration of administration is shorter than that being used in the USA (7-14 days) and seems to be too short because in several patients the HSV culture is still positive after 5 days of administration of ACV. To prevent recurrence, suppressive therapy using ACV has been introduced but has not yet been approved by social insurance. Biological response modifiers such as PS-K (a protein-bound polysaccharide) or Lactoferrin are being tried to reduce the recurrence rate. The susceptibility of HSV strains to ACV which had been isolated in 1970 s, 1980s, and 1990 s was examined by a plaque assay which elucidated an almost similar susceptibility among these isolates.

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We surveyed postoperative infection prophylaxis to determine a consensus on the administration of antimicrobial prophylactic (AMP) agents among surgeons in Japan. Questionnaires were sent to 643 surgeons, with a 63% response of 406, 88 from 133 general surgeons (66%), 52 from 83 cardiac surgeons (63%), 45 from 82 neurosurgeons (55%), 50 from 91 orthopedists (55%), 56 from 83 gynecologists (68%), 63 from 87 urologists (72%), and 52 from 84 otolaryngologists (62%). They reached a consensus that the first dose of an AMP agent should be administered within 30 minutes before surgery by intravenous drip infusion, and that additional intraoperative dosing is required to maintain therapeutic levels throughout the prolonged operations. Even in clean surgery, short-term prophylactic use was not supported by any surgeons, ranging from shortest within 2 days by general surgeons to longest within 7 days by neurosurgeons. Surgeons who expected the AMP agent to prevent surgical site infection (SSI) and remote infections supported significantly longer prophylactic use than those targeting the prevention of SSI alone (p<0.05).

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We studied acute purulent otitis media pathogens in 33 children treated at ear, nose, and throat outpatient clinics of 4 general hospitals in Shizuoka Prefecture, Japan, from December 1998 to January 1999. The 58 isolates from the 33 cases were bacteriologically investigated focusing on antimicr obial resistance and susceptibility to cephalosporins which are frequently prescribed in Japan. Cultures showed that Streptococcus pneumoniae was detected in 64% of the nasopahryngeal swab isolates and Hae mophilus influenzae in 52% but S. pneumoniae was detected in only 33% and H. influenzae in only 21% of middle ear discharge. Penicillin resistant S. pneumoniae (PRSP), penicillin intermediately resistant S. pneumo-niae (PISP) was identified in 65O and in 15% of the 20 cases in which S. pneumoniae was detected in cultures. The measured minimal inhibitory concentrations (MICs) of penicillin G against PRSP showed peak distribution at 2, μg/mL. Susceptibility testing with cephalosporins cefaclor, cefdinir, cefpodoxime, and cefditoren (CDTR) against S. pneumoniae and H. influenzae showed marked discrepancies in results among agents. CDTR seemed the most effective in vitro against S. pneumoniae and H. influenzae. We concluded that antimicrobial resistance had dramatically increased among S. pneumoniae and H. influenzae, causing acute purulent pediatric otitis media.

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We studied susceptibility testing to isepamicin (ISP) of aminoglycosides and antibacterials fbr extended-spectrum β-lactamase (ESBL) producing gram-negative rods in MICs of 14 antibacterial agents, aminoglycosides, and β-lactams against ESBL producing gram-negative rods, Bacterial strains were 50 clinical isolates, 5 CTX-M-1-related and 23 CTX-M-2-related (CTX-M-type)β-lactamase producers, 12 SHV-12, 1 SHV-2, 1 SHV-24, and 1 TEM-26 (TEM-and SHV-derived) ESBL producers. MICs of ISP ranged is from 0.12 to 32μg/mL, MIC₅₀. was 0.5 μg/mL and MIC₉₀ H, was 2μg/mL. Our results suggest that ISP is an effective antibacterial agent against extended-spectrum β-lactamases, including TEM-and SHVderived ESBL and CTX-M-type β-lactamases, producing gram-negative rods.

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