Recently many antimicrobial agents are used for treatment of infectious diseases.These agents are known to potentially have adverse effects.The adverse effects of antimicrobial agents are classified to two major groups; 1) concentration-independent effects and 2) concentration-dependent effects.Large part of the mechanism of these adverse effects remains unclear.In this paper, we will discuss the mechanisms of aminoglucoside-and glycopeptide-induced nephropathy, aminoglycoside-induced ototoxicity, β-lactam-and quinolone-induced convulsions, cephem-induced bleeding tendency and antabuse-like effect, and quinolone-induced hypeglycemia.

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In vivo efficacy of biapenem (BIPM) against mouse pseudomonal pneumonia infection was compared to that of imipenem/cilastatin (IPM/CS) and meropenem (MEPM).All carbapenems showed high therapeutic efficacy against sensitive P.aeruginosa. BIPM efficacy against the MexAB-OprM overproducing strain was superior to IPM/CS and MEPM.Therapeutic response of BIPM against MexAB-OprM overproducing and MexCD-OprJ producing strain was superior to MEPM and similar to IPM/CS.BIPM effectiveness was compared to IPM/CS and MEPM using a mouse model infection with different inoculum size.In 10⁵ order CFU/lung, therapeutic efficacy of BIPM, IPM/CS, and MEPM was comparable, but in 10⁶ order CFU/lung, BIPM showed higher efficacy than IPM/CS or MEPM.

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Background: Since an injectable new quinolone, ciprofloxacin (CPFX) was approved for clinical use in Japan, it has attracted attention as a new treatment option for infection.The clinical position of CPFX has yet to be established, however.
Objectives: To clarify the clinical position of CPFX in the treatment of respiratory tract infection.
Patients and Methods: Patients with pneumonia or exacerbated chronic respiratory tract infection refractory to penicillin or cephem antibacterial agents were randomized to be administered CPFX by intravenous infusion (300 mg bid) or carbapenem by intravenous infusion (0.3-0.5 g bid), and the efficacy, safety, duration of hospitalization, and duration of antibacterial therapy were compared between groups.
Results: Among 83 patients enrolled in the study.78 complying with the protocol were evaluated for safety (safety analysis set) and 68 for efficacy (efficacy analysis set).The two groups were similar in age, gender ratio, infection diagnosis and severity, and prior antibacterial therapy.Efficacy was comparable between groups, at 82.7%(24/29 patients) in theCPFX group and 71.0%(22/31 patients) in the carbapenem group.The number of patients who improved early and could cease treatment with the study drug was greater in the CPFX group (p<0.05).No significant difference was noted between groups in duration of hospitalization or duration of therapy. The incidence of adverse drug reactions (adverse events for which a causal relationship to the study drug could not be ruled out) was 13.5%(5/37 patients) in the CPFX group and 12.2%(5/41 patients) in the carbapenem group, and none in either group experienced serious adverse reactions.
Discussion: In patients with respiratory tract infection refractory to penicillin or cephem antibiotics, CPFX showed at least comparable clinical efficacy to that of carbapenem and achieved a higher early improvement rate.These results suggest that CPFX is a viable option for the treatment of respiratory tract infection.

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To evaluate the efficacy of the oral cephem antibiotic cefcapene pivoxil (CFPN-PI) against complicated noncatheterized urinary-tract infections, we conducted a comparative study by the envelope method using the quinolone antibiotic levofloxacin (LVFX), as the comparative drug.Both drugs were administered at 100 mg per dose 3 times a day for 7 days.Clinical efficacy was evaluated based on the UTI Drug Efficacy Evaluation Standards (4^th edition).No significant difference in background factors was seen between groups.
In early-phase evaluation, overall clinical efficacy was 84.4% among 32 cases in the CFPN-PI administration group and 86.1% among 36 cases in the LVFX administration group.
When late-phase microbiological outcome was evaluated 1 week after the completion of administration, 66.7% was judged “eradicated” and 33.3% “failed” among 27 cases in the CFPN-PI group and 81.5% “eradicated” and 24.1% were judged “eradication” and “failed” among 29 cases in the LVFX group.
When the microbiological outcome was evaluated for healing at 1 month after the completion of administration, 76.4% was judged “eradicated” and 23.1% “failed” among 13 cases in the CFPN-PI group and 58.3% “eradicated” and 41.7% “failed” among 12 cases in the LVFX group.No significant difference was seen between groups in any evaluations.
Side effects were observed in 1 of 77 cases (1.3%) in the CFPN-PI group and in 3 of 75 cases (4.0%) in the LVFX administration group, with no significant difference between groups.
CFPN-PI thus showed effects similar to LVFX and was found to be useful against bacterial strains adopted in complicated noncatherized urinary-tract infection when treatment outcomes for healing at 1 month was evaluated as the endpoint using UTI Drug Efficacy Standards (4^th Edition).

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