We studied 304 meningitis cases, including 18 cases pneumococcal meningitis confirmed by direct PCR for cerebrospinal fluid between 1993 and 2003. We analyzed isolates of 199 strains from children and isolates of 105 strains from adults to determine antibiotic susceptibility, genotype of penicillin-binding protein (PBP) genes, and the serotype distribution of isolates. Isolates in which abnormal PBP genes of pbp 1 a, pbp 2 x, and pbp 2 b were identified by PCR were classified based on PCR results and MIC⁹⁰ of penicillin G as follows:(i) PSSP with 3 normal PBP genes (23.1%, MIC⁹⁰: 0.031 pg/mL), (ii) PISP with an abnormal pbp 2 x (19.9%, MIC⁹⁰: 0.063μg/mL);(iii) PISP with an abnormal pbp 2 b (0.7 MIC⁹⁰: 0.125, μg/mL);(iv) PISP with abnormal pbp 2x and pbp 2 b (5.9%%, 0.25μg/mL);(v) PISP with abnormal pbp 1 a and pbp 2 x (10.5%, 0.25μg/mL); and (vi) PRSP with 3 abnormal PBP genes (39.9%, 2μg/mL). The incidence of PRSP, PISP having abnormal pbp 1 a and pbp 2 x, and PISP having an abnormal pbp 2x in the last 3 years was significantly higher rather than in preceding years. The incidence of PRSP was also significantly higher in children (45.3%) than in adults 27.1% Panipenem showed an excellent MIC⁹⁰ of 0.125μg/mL against PRSP, followed by biapenem (0.25μg/mL), meropenem and vancomycin (0.5μg/mL), cefotaxime (1μg-/mL), ceftriaxone (2μg/mL), ampicillin (4μg/mL), and cefotiam (8μg/mL). Significantly prevalent pneumococcal serotypes of isolates from children were 6 B (25.4%), 19 F (19.0%), 23 F (13.8%), 6 A (10.1%), and 14 (7.9%), in that order, compared to 23 F (16.5%), 22 (12.4%), 3 (11.3%), 6 B (10.3%), 19 F (9.3%), and 10=14 (6.2%%) in adults. Serotypes of isolates from both generations differed significantly (X²=56.9656, p=0.0000 (**)). PRSP was more prevalent in serotypes in strains from children. For isolates in the last 3 years, in children, sevenvalent pneumococcal conjugate vaccine covered isolates in 76.7% and eleven valent vaccine 81.7 but coverage was apparently low in adults at 43.8% and 56.3%. These findings suggest the need to introduce conjugate vaccine at the earliest opportunity and to continue nationwide monitoring of meningitis in Japan.

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Many package inserts state that concurrent therapy of quinolones with non-steroidal anti-inflammatory drugs (NSAIDs) is contraindicated, or careful patient monitoring is advised. However, the current status of concurrent therapy with these classes of agents has not been clarified. In this study, we surveyed the current status of concurrent therapy with these two classes of agents based on prescriptions in 2 urban hospitals, Mitsui Memorial Hospital and Sanraku Hospital. Between January 2002 and February 2002, 88, 159 outpatient clinic prescriptions (Mitsui Memorial Hospital: 51, 195 prescriptions, Sanraku Hospital: 36, 964 prescriptions) and 13, 692 inpatient prescriptions (Mitsui Memorial Hospital: 9, 543 prescriptions, Sanraku Hospital: 4, 149 prescriptions) were recorded. Quinolones were prescribed in 1.7% of the prescriptions in Mitsui Memorial Hospital and in 0.8% of the prescriptions in Sanraku Hospital The most common quinolone was levofloxacin (82.5% of all quinolone prescriptions), and it was followed by ciprofloxacin (8.9%). NSAIDs and/or antipyretic/analgesic drugs were prescribed in combination in 30.6% of quinolone prescriptions in Mitsui Memorial Hospital and in 13.5% of those in Sanraku Hospital. As to NSAIDs and antipyretic/analgesic drugs, acetaminophen and acetaminophen preparations were most frequently prescribed (56.8%), and they were followed by loxoprofen sodium and mefenamic acid. We also surveyed cephem prescriptions at the same time. Cephems were prescribed for concurrent therapy with NSAIDs and/or antipyretic/analgesic drugs in 58.3% of outpatient cephem prescriptions (47.9) of all cephem prescriptions). These results showed that concurrent therapy with quinolones and NSAIDs is prescribed in clinical practice. The safety of such combination therapy should be established, and the interactions between these drugs should be clarified separately.

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We studied the minimum inhibitory concentrations (MICs) of ampicillin (ABPC), piperacillin (PIPC), cefotaxime (CTX), ceftriaxone (CTRX), meropenem (MEPM), and amoxicillin/clavulanic acid (AMPC/CVA) using Etest against 150 strains of Haemophilus influenzae isolated from upper nasopharyngealswabs in children with respiratory tract infection between August 2002 and March 2003. Subjects rangedin age from 1 month to 14 years. Of 150 isolates, β-lactamase-negative ABPC-susceptible (BLNAS) strains account for 60 (40.0%), β-lactamase-negative ABPC-resistant (BLNAR) strains for 84 (56.0%), β-lactamase-positive ABPC-resistant (BLPAR) strains for 5 (3.3%), and β-lactamase-positive AMPC/CVA-resistant (BLPACR) strains for 1 0.7 (%). Of 84 BLNAR, MICs to ABPC of 36 strains weremore than 4 μ/mL and those of 48 were more than 2 and less than 4 μ/mL. The MIC₉₀ was 0.25 μ/mL inCTRX, 0.25μ/mL in PIPC, 0.5 μ/mL in MEPM, 2μ/mL in CTX and 8μg/mL in ABPC. MIC90s ofBLNAS and BLNAR were 1.5 and 8 μ/mL in ABPC, 0.125 and 0.25μ/mL in PIPC, 1.5 and 8μg/mL inCTX, 0.125 and 0.38 μ/mL in CTRX, and 0.19 and 0.5 μ/mL in MEPM.

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Multiresistant gram-positive cocci including MRSA have become notorious attention as pathogens causing nosocomial infections. Although VCM and other glycopeptide antibacterials are specifically active against these bacteria, VRE and VRSA resistant to these drugs have emerged as a problem. We studied the antibacterial activity of a new antibacterial agent linezolid (LZD) and other drugs against methicillinresistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, coaglase-negative staphylococci (CNS) other than Staphylococcus epidermidis, Streptococcus pneumoniae 3, and vancomycin-resistant enterococci (VRE). The antibacterials tested were LZD, imipenem (IPM), bibapenem (BIPM), arbekacin (ABK), levofloxacin (LVFX), vancomycin (VCM), and teicoplanin (TEIC). MIC against staphylococci was 0.5-4μg/mL for LZD, 0.25-2μg/mL for VCM, ≤ 0.06-8μg/mL for TEIC, and ≤ 0.06-2μg/mL for ABK, with no tendency for tolerance observed for these drugs. Test bacteria tended to become resistant to IPM, BIPM, and LVFX. S. pneumoniae, which is currently causing problems due to the emergence of PISP and PRSP, showed no tendency to become resistant to the drugs tested other than ABK. VRE tended to become resistant to all antibacterials tested other than LZD, against which the strain showed no tendency toward resistance.

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Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of infection in hospitalized patients, most of whom require intravenous administration of vancomycin because these organisms are frequently multidrug-resistant. We report an 81-year-old man with MRSA sepsis successfully treated with linezolid. Although MRSA isolated from the patient was susceptible to vancomycin in vitro, it proved to be clinically ineffective. Linezolid thus appears to be an excellent alternative to vancomycin for patients with MRSA infection.

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We studied the in vitro antiviral activity of commercially available povidone-iodine (PVP-I) products against murine hepatitis virus (MHV) A-59 strain, a murine coronavirus. All commercial products, i.e., PVP-I solution, PVP-I gargle, PVP-I scrub, PVP-I palm, and PVP-I throat spray, decreased viral infectivity titer beyond 4 logs within 5 seconds at concentrations of 0.1% to 5% of PVP-I. These results demonstrate the strong antiviral activity of PVP I products against murine coronavirus.

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