The emergence of antibiotic resistance in pathogens responsible for the majority of upper respiratory tract infections, such as acute otitis media (AOM), has made the appropriate selection of antibiotic therapy more critical than ever. Nasopharyngeal cultures may be a rapid and practical alternative to tympanocentesis in the selection of an appropriate and effective treatment. The recent development of a clinical scoring system to evaluate the severity of an episode of AOM, along with an analysis of risk factors that may be present, should provide further guidance for the management of AOM. Polymerase chain reaction and pulsed-field gel-electrophoresis should be useful for determining genetic alterations in penicillin-binding protein genes and deciding whether a particular AOM case is the result of reinfection or infection with a new strain, enabling a more effective management of this disease. Recent research has demonstrated that specific host immunity to certain pathogens is a reliable measure of an individual's susceptibility to otitis, making the need for AOM immunoprophylaxis imperative. Some children with subtle immunologic deficits are prone to recurrent episodes of otitis media. Unfortunately, these immunologic differences make the task of developing effective vaccines even more daunting. Our research on nasal vaccines may be a breakthrough for mucosal immunity. Preliminary studies suggest that intranasal vaccination with the outer membrane protein of Haemophilus influenzae produces both nasalspecific IgA and serum-specific IgG. In addition, new DNA vaccines currently in development offer promise for the prevention of bacterial infections such as AOM. All of these approaches should aid in the improved management and prevention of intractable upper respiratory tract infections.

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Using the agar dilution method, the susceptibility of Staphylococcus aureus (including MRSA), Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa, to various antimicrobial agents was examined. All strains were isolated from patients with complicated urinary tract infections (UTIs) who visited the Department of Urology at Kagoshima University Hospital, between January and December 1999. An inoculum size of 10⁶ CFU/mL was used. Vancomycin exhibited the most potent antibacterial activity against S.aureus and E.faecalis, with an MIC₉₀ of 1.56μg/mL. All carbapenems showed potent antibacterial activity against E.faecalis, with an MIC₉₀ of less than 12.5μg/mL. All carbapenems and most of the cephems exhibited potent antibacterial activities against E.coli, with that of meropenem (MEPM) being especially high (the MIC₉₀ was less than 0.025μg/mL). MEPM exhibited the strongest antibacterial activity against P.aeruginosa, with an M1C₉₀ of 3.13μg/mL. In a regression analysis, positive correlations were observed between the MICs of MEPM and imipenem (IPM), MEPM and panipenem (PAPM), and IPM and PAPM in the tested strains. The correlation coefficients ranged between 0.753 and 0.995. A comparison of the MICs of carbapenems against S.aureus, E.faecalis, E.coli and P.aeruginosa strains isolated between 1997 and 1998 and urinary isolates obtained in 1999, showed no tendency towards drug resistance in the uroisolates.

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We studied changes in the susceptibility of clinical isolates to faropenem and other antibiotics with samples collected from patients with respiratory or urinary tract infections at 382 facilities in Japan. Surveys were conducted 3 times every 2 months from February 1 to March 31 during 1998 to 2000. The incidence of methicillin-resistant Staphylococcus aureus (MRSA) was about 7% of all S. aureus isolates and that of methicillin-resistant Staphylococcus epidermidis (MRSE) was 26.3% to 29.6% of all S.epidermidis isolates. The incidence of penicillin-resistant Streptococcus pneumoniae increased from 27.3% to 45.7% of all S.pneumoniae isolates in 3 years. Imipenem (IPM) and faropenem (FRPM) had strong antibacterial activity against methicillin-usceptible S.aureus (MSSA) and methicillin-susceptible S.epidermidis (MSSE) and PRSP. All β-lactam antibiotics had strong antibacterial activity against Streptococcus pyogenes. Clavulanic acid/amoxicillin (CVA/AMPC) had strong antibacterial activity against Enterococcus faecalis. Levofloxacin (LVFX) and IPM had strong antibacterial activity against gramnegative bacteria such as Branhamella catarrhalis and Escherichia coli. LVFX was the most active against Klebsielliaceae and other Enterobacteriaceae. The incidence of ampicillin-resistant Haernophilus influenzae was from 30.4% to 37.1% of all H. influenzae isolates in 3 years. LVFX was the most active against ampicillin-resistant Haemophilus influenzae. FRPM exhibited excellent antimicrobial activity against almost all strains except for MRSA and MRSE. The susceptibilities to FRPM of these strains have not changed among 3 years.

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Combined antibacterial therapy with sulbactam/ampicillin (SBT/ABPC) and aztreonam (AZT) was given to 51 patients with infections associated with hematological disease. Among the 41 evaluable patients, 15 (36.6%) had acute leukemia, 18 (43.9%) malignant lymphoma, 6 (14.6%) multiple myeloma, 1 (2.4 %) myelodysplatic syndrome, and 1 (2.4%) chronic lymphocytic leukemia. The overall response to this treatment was 61.0%, and those for individual infections were 65.5% for suspected sepsis and 60.0% for pneumonia. The response was 66.7% for patients with acute leukemia, and 58.8% those with malignant lymphoma. In elderly patients, response is relatively low. Patients with neutropenia are resistant to current antibacterial therapy. No side effects of a high grade were seen in evaluable patients. This combination therapy is effective for various infections in patients with hematological malignancy.

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The safety of cefditoren pivoxil (brand name: MEIAC^®Tablets 100), an oral cephem antibiotic, in pregnant women and infants was studied retrospectively in practical use. Parameters were subjects' background factors-age, pregnancy history; dosing regimen-dose, administration duration; concomitant drugs and therapies; adverse drug reactions and adverse events; laboratory tests; information on delivery - pregnancy course, information on the mother at delivery; and information on infants-follow-up in neonates, 1-month-old infants, and, where possible, 1-year-old infants. Of the 148 subjects reported to have taken the drug during pregnancy by physicians, 136, excluding 12 exclusions and dropouts, were judged eligible for analysis. Of these, 127 were followed up for 1 month after delivery and 35 for 1 year after delivery. Subjects eligible for analysis were (1) 1 taking the drug between 4 and 7 weeks of pregnancy (absolute risk duration)(5 weeks of pregnancy), (2) 17 taking the drug between 8 and 15 weeks of pregnancy (relative risk duration), and (3) 118 taking the drug in and after the 16 th week of pregnancy (41st week at the latest). Neither adverse drug reactions nor adverse events were observed in these women due to cefditoren pivoxil administration nor were abnormal findings attributable to drug administration observed in infants.

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