We organized bacteriological by analyzed pathogens causing infection in dentistry and oral surgery in adults for which oral antibiotics were used.
1) 331 strains were isolated from 145 cases, including 84 of periodontitis, 51 ofjaw osteitis, and 10 of pericoronitis treated at 3 primary and 9 secondary medical practice facilities nationwide.
2) No difference was seen between primary and secondary facilities in the ratio of erobic and anerobic bacteria, infection type, and microorganisms distribution.
3) By bacterial strain, oral Streptococcus bacteria, including 40 Streptococcus constellatus strains, constituted 80.6% of erobic bacteria. Peptostreptococcus spp. was dominant at 44.3% of anerobic bacteria, followed by 25.9% of Prevotella spp.
4) When 4 antibacterial drugs were analyzed by cumulative MIC of 0.39 μg/mL, the order was as follows: AMPC (90%), CFPN (89%), CFDN (81%), and CAM (76%).
5) The sensitivity of oral Streptococci was examined from antibacterial activity in the clinical trial for CFPNPI and in the present study, which took place 10 years later. At MIC below 0.05 μg/mL, sensitivity was lower in the present study, but at a MIC of 0.39 μEg/mL, at which clinical efficacy was expected to be optimal, it was similar at 96.9% compared to 97.4%.
6) Very few differences were seen in antibacterial activity between primary and secondary institutions.

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Between April 2002 and March 2004, 533 Streptococcus pyogenes isolates were collected from pediatric outpatients with pharyngotonsillitis. The susceptibility of 14 antibiotics (8 β-lacatams, 4 macrolides, clindamycin, and telithromycin) were determined against these isolates. The MIC_90s of β-lactams were as follows: cefditoren=cefdinir=cefcapene (0.008μg/mL), cefpodoxime (0.016μg/mL), ampicillin=amoxicillin=faropenem (0.031μg/mL), and cefaclor (0.125μg/mL). The MIC90 of telithromycin was 0.031μg/mL. Erythromycin, clarithromycin, and azithromycin of macrolides were less active than β-lacatams. We also determined the presence or absence of macrolide-resistance genes of ermB, mefA, and ermTR for all isolates by PCR. Of 533 isolates, 17 strains (3.2%) had the ermB gene, 26 strains (4.9%) the mefA gene, and 3 strains (0.5%) the ermTR gene. Strains having the ermB gene showed high resistance to all macrolides tested, and strains having the mefA gene were resistant to these agents with MIC_90S of ≥ 1μg/mL, except for josamycin and clindamycin. The susceptibility to macrolides of strains having the ermTR gene was similar to that of strains having the mefA gene. Predominant T types were T12 (32.3%), followed by T4 (18.8%), T1 (10.1%), T13 (8.3%), and T25 (7.5%). Macrolide-resistance strains were distributed in T types, but among strains having the mefA gene, more than half were T25 showing an increase. These results suggest that continuous surveillance for Streptococcus pyogenes is required.

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In vitro activity of faropenem (FRPM) against anaerobic species isolated in 1998, 2000, 2002 was investigated and compared with those of eight other oral agents and imipenem (IPM), as a post marketing surveillance of FRPM. The organisms tested comprised Bacteroides fragilis (25 strains in each year), Bacteroides thetaiotaomicron (25, 25, and 14 strains in 1998, 2000, 2002, respectively), pigmented Prevotella spp.(25, 24, and 25strains in 1998, 2000, 2002, respectively), Propionibacterium acnes (25 strains in each year), and anaerobic gram-positive cocci (Peptostreptococcus anaerobius, Peptoniphilus asaccharolyticus, Finegoldia magna, and Micromonas micros)(25 strains in each year). FRPM was the most active oral agent against those anaerobes with the MIC₉₀ of≤0.06 to 4 μg/mL. Activity of FRPM was much the same as that of IPM to most of anaerobes tested. In comparison of the values of MIC₅₀ and MIC₉₀, during the period of this survey, any significant changes of those values for FRPM were not observed.

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We studied the efficacy of cefcapene pivoxil (CFPN-PI, trade name: Flomox) against adult infection in dentistry and oral surgery for which oral antibiotics we are used.
1) At 3 primary facilities and 9 secondary medical practice facilities nationwide, CFPN-PI was administered in 146 cases: 84 of periodontitis, 10 of pericoronitis, and 52 of jaw osteitis.The daily dose was 300mg in 139 and 450 mg in 7 cases.
2) CFPN-PI was effective (judged by the primary physician) in 76 of 84 cases of periodontitis (90.5%), 8 of 10 of pericoronitis (80.0%), and 49 of 52 of jaw osteitis (94.2%), i.e., 133 overall (91.1%). Efficacy was higher at secondary than primary medical facilities at, 93.3% versus 87.7%.
3) Efficacy, by age, was 84.8% in young adults (age: 17 to 45), 92.1% in middle-aged adults (age: 46 to 65), and 97.3% in older adults (age: 66 to 83). Eefficacy by daily dose was 91.4% in the 300 mg/day group and 85.7% in the 450 mg/day group.
4) Efficacy judged on day 3 based on the Evaluation Standards of Antibiotic Efficacy in the Areas of Dentistry and Oral Surgery was 54 of 59 in periodontitis (91.5%), 5 of 7 in pericoronitis (85.7%), and 35 of 38 in jaw osteitis (92.1%), i.e., 95 of 104 overall (91.3%). It was higher at secondary than at primary medical facilities at, 92.9% versus 88.2%.
5) When efficacy was compared to that at the new drug symposium, it was similar at 89.8% compared to 91.1% by the physician's judgment and 91.2% to 91.3% for day 3 judgment.
6) Mild adverse reactions were observed in 2 of 153 cases (1.4%).
Based on these results, we concluded that cefcapene pivoxil is a useful agent fortreating odontogenic infection in doses of 300mg/day.

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To evaluate the clinical efficacy of antibiotics in treating Streptococcus pyogenes (GAS) pharyngotonsillitis, we studied 622 pediatric outpatients at Hakujikai Memorial Hospital between February 2001 and July 2003. Patients had been diagnosed with GAS pharyngotonsillitis based on clinical signs, throat cultures, and a rapid antigen detection test of GAS. The following antibiotics were randomly assigned to patients by the day of the week: amoxicillin, cefaclor, cefditoren pivoxil (PI), cefcapene pivoxil (PI), clarithromycin, and azithromycin. Throat cultures were obtained before treatment and on a follow-up visit 7 to 10 days after completion of antibiotic treatment, and GAS eradication among these agents was compared.
Cefditoren PI showed the highest eradication (149/158 patients; 94.3%), followed by amoxicillin (98/110; 89.1%), cefcapene PI (111/128; 86.7%), clarithromycin (63/75; 84.0%), cefaclor (65/80; 81.3%), and azithromycin (54/71; 76.1%). Cefditoren PI significantly reduced failure compared to antibiotics other than amoxicillin.
Of patients who had positive strains of macrolide resistance gene of mefA or ermB, eradication of GAS was failured in all episodes after treatment with clarithromycin or azithromycin (n=11).
Our data suggests that β-lactam antibiotics are more proper agents than macrolides in treating GAS pharyngotonsillitis.

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Using broth micro dilution, we studied the susceptibility of 145 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Enterobacteriaceae to meropenem (MEPM) and reference agents. All strains were isolated from the blood of patients admitted to Keio University Hospital between September 2002 and March 2003.
1. MEPM and other carbapenems showed excellent antibacterial activity against most blood culture isolates, except for drug-resistant staphylococci (MRSA and some S. epidermidis). A comparison of antibacterial activity of MEPM with that in previous studies showed no marked increase in MEPM-resistant clinical isolates.
2. MEPM differed microbiologically from imipenem, panipenem, and biapenem in its greater potency in vitro against most Gram-negative pathogens, including P. aeruginosa, and similar potency against many Grampositive pathogens. Resistance to MEPM in clinical isolates of P. aeruginosa was lowest among the 4 carbapenems tested.
MEPM thus retains its potency as the agent of choice in treating serious infections.

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