Candins, a novel class of antifungal agent, inhibit 1, 3-β-D-glucan synthase that plays an essential role in fungal cell wall synthesis. Three compounds of candin, anidulafungin, caspofungin, and micafungin, have been developed. Each has strong in vitro antifungal activity against major deep-eated fungal pathogens such as Aspergillus spp. and Candida spp. including native azole-esistant spp. Candins also have been shown to extend animal survival in both systemic and respiratory experimental infections with Candida spp. or Aspergillus spp. Although anidulafungin is still in phase II clinical trials, caspofungin has already been approved by the US FDA in 2001. Micafungin was originally synthesized and developed in Japan. Since clinical studies showed that micafungin was also effective against aspergillosis and candidasis, the 2 most common fatal mycoses in Japan, micafungin is expected to be approved in Japan soon.

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Extracellular ATP stimulates a wide variety of cell types, including macrophages(MΦs), by ligating of plasma membrane purinergic receptors. Treatment of human MΦs with ATPΦ is reported to potentiate MΦ activity in killing Mycobacterium tuberculosis(MTB). We studied the effects of ATP on the in vitro and in vivo antimicrobial activity of murine MΦs against Mycobacterium avium complex(MAC). While ATP at concentration of 3-5mM up-regulated the antimicrobial activity of MΦs against MTB dose-dependently, this was not noted for MΦs infected with MAC organisms, although intramacrophage MAC growth was weakly inhibited in ATP-treated MΦs under certain conditions. When MAC-infected mice were subcutaneously given ATP at 40 mg/kg dose, once daily, 5 times per week, for up to 8 weeks after infection, bacterial growth in the lungs was inhibited significantly during the first 2 weeks compared to control mice without ATP administration. This effect on the intrapulmonary MAC growth was no longer observed after week 2, and MAC grew much more rapidly thereafter in mice given ATP than in the control mice. ATP didnot, however, affect MAC bacterial growth in the spleen. These findings show that ATP affects MTB antimicrobial activity against MAC negatively, in contrast to the positive effect against MTB. The finding that ATP administration inhibited MAC organism growth in the lungs of infected mice in the early stages of infection suggests that ATP may be useful in treating MAC infections when given in combination with anti-MAC antimicrobials.

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We surveyed the susceptibility of Streptococcus pneumoniae to antibacterial agents isolated from acute middle-ear otitis media in infants and children between January 1998 and December 2000. A total of 710 strains were isolated during these periods. Penicillin-susceptible S. pneumoniae (PSSP) accounted for 245 strains (34.5%), penicillin-intermediate resistant S. pneumoniae (PISP) for 336 strains (47.3%), and penicillin-resistant S. pneumoniae (PRSP) for 129 strains (18.2%). The rate of certain resistance did not change during this period. The sensitivity to antimicrobial agents tended to deteriorate, but other antimicrobial agents tended to improve. In general, we found that antimicrobial agents had previously been good but had generally fallen during these periods. Sensitivity to individual drugs at MIC₉₀ in all detected bacteria strains was as follows: only cefditoren (CDTR) and levofloxacin (LVFX) showed less than 1.0μg/mL, while other antimicrobial agents benzylpenicillin (PCG), ampicillin, cefpodoxime showed 2.0μg/mL. Other antimicrobial agents showed more than 4.0μg/mL, demonstrating considerable resistance by S. pneumoniae to oral antimicrobial agents. In PSSP, antimicrobial agentsbesides cefaclor, cefdinir, erythromycin, clindamycin and minocycline showed good sensitivity. However, in PISP and PRSP, S. pneumoniae showed considerable resistance to antimicrobial agent except CDTR and LVFX. Comparing PCG and penicillins antimicrobial agents and cephem antimicrobial agents, the resistance of S. pneumoniae to penicillins antimicrobial agents did not change, the same as PCG, by chemical sensitivity, but 1 component of cephem antimicrobial agents showed increased resistance rates among S. pneumoniae. However, it was not clear whether resistance to antimicrobial agents among S. pneumoniae has changed or not in recent years. This study showed that the progress ion in the resistance of S. pneumoniae is not clear, but the sensitivity to CDTR that was excellent a few years ago against PRSP has decreased in PRSP and PISP. We emphasize that we must reconsider the method (triple or twice) and dosage of CDTR for acute otitis media caused by S. pneumoniae in infants and children.

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We compare infection between different durations of antibiotic prophylaxis after transrectal prostatic biopsy. Of 77 patients undergoing this procedure, 39 received 100mg t.i.d of levofloxacin (LVFX) for 3 days and 38 received 100mg t.i.d of LVFX for 7days. Febrile complication of urinary tract infection developed in only 1 patient (2.6%) in the 3day group. No significant difference was seen between groups. Oral administration of 100 mg t.i.d. of LVFX for 3 days was sufficient to prevent symptomatic urinary infection after transrectal prostatic biopsy.

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The use-results surveillance study of Farom^® dry syrup for pediatric (faropenem, FRPM) was conducted from the time of sale in 1999 to 2002, covering 3, 823 cases at 630 institutions nationwide. Of these, safety was analyzed in 3, 612 and efficacy in 3, 422. Results for safety were as follows: 1. The incidence of adverse drug reactions (ADRs), including abnormal laboratory findings in the Use-results surveillance data, was 10.19%(368 cases), higher than 8.18%(48/587) inpremarketing studies.
2. Major of ADRs were gastrointestinal disorders at 9.83%(355 cases) including diarrhoea, wastery stool, loose stools and mushy stool. Other ADRs were skin and appendages disorders at 0.42%(15 cases).
These symptom were slight, and resolved after administration of this agent was stopped. We confirmed a higher incidence of ADRs in younger patients, i.e., less than 3 years old patient, and these ADRs was almost appeared within 3 days.

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