Fungal infection is still a life-threatning complication in patients with hematological malignancies or in those undergoing hematopoietic stem cell transplantation. Because of the poor prognosis of patients treated with amphotericin B after the confirmation of fungal infection, its empirical use is recommended for febrile neutropenic patients refractory to broad-spectrum antibiotics after 3-7 days. However, the actual incidence of fungal infection in these patients is unknown. Therefore, a considerable number of patients may have been overtreated using this approach. New drugs that are safer and more effective than amphotericin B, especially against Aspergillus, and newer diagnostic tools are now being introduced. The usefulness of empiric antifungal therapy is now being debated because of its high cost, especially using the new antifungal drugs. Recently, preemptive therapy and presumptive therapy were introduced in this field. Preemptive therapy is used for patients exhibiting early preclinical signs of fungal infection but no overt disease. Presumptive therapy is initiated for patients with fever refractory to broad-spectrum antibiotics who are positive for surrogate markers of fungal infection but do not have a probable/proven fungal infection. Appropriate approaches for early antifungal therapy in high-risk patients are discussed.

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The antitumor activity of combined chemoendocrine therapy, fluoropyrimidine derivatives and tamoxifen (TAM), was examined with three human breast carcinoma xenografts, MCF-7, R-27, and Br-10, which are estrogen receptor (ER) positive tumors. Treatments based on maximum tolerated doses were initiated in four groups: control, 5-fluorouracil (5-FU) 60 mg/kg i.p. every four days for a total of three times, S-1 20 mg/kg (as tegafur) p.o. five times a week for three weeks, and TAM 5 mg/kg p.o. six times a week for three weeks. The antitumor activity of each agent were assessed by the T/C (treated/control) ratio of relative mean tumor weight. Values for 5-FU with MCF-7, R-27 and Br-10 were 68.6, 80.4, and 52.7%, and those for S-1 were 49.0, 60.0, and 29.6%, showing higher antitumor activity than 5-FU. For TAM, values were 50.5, 62.3, and 39.8%. The activity of combination therapy, 5-FU+TAM and S-1+TAM, was tested with R-27 which showed the lowest sensitivity to each of the three agents. Values were 51.9% for 5-FU+TAM and 28.7% for S-1+TAM. Determination in thymidylate synthase (TS) inhibition and dihydropyrimidine dehydrogenase (DPD) activity then measured to examine the role of 5-FU metabolism in the antitumor effect enhancement, which showed no statistically significant difference between treatment groups, S-1 alone and S-1+TAM. 5-FU concentrations in the tumor also showed no statistically significant differences between groups. It is negative that 5-FU in the tumor is modified by TAM and another mechanism might contribute to the enhancement of antitumor effect with this combination. S-1+TAM appears to be a promising combination against advanced or recurrent hormone receptor positive breast cancer.

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We studied the efficacy and safety of teicoplanin (TEIC) in renal dysfunction patients with MRSA infection, andthe validity ofthe recommended dosage regimens as related tothe degree of renal function, that are currently recommended for use.
23 patients were examined, and the safety rate was 80.0%(16/20), excluding three non-evaluable patients from the group used for evaluation. The efficacy rate was 72.2%(13/18), after excluding two non-evaluable patients, and 90.9%(10/11) in the group on a daily dosage of 400 mg, and 3/7 in the group on a daily dosage of 200 mg. In the patient group with Ccr≤10, including dialysis patients, the trough serum level concentration, which is important to judge efficacy, had decreased greatly by the ninth day compared with other groups.
We conclude that the dosage interval for TEIC in the patient group with Ccr>10 is appropriate, and a daily dosage of 400 mg is preferable. This study also showed the necessity for reexamination of the dosage interval in patients with Ccr≤10, including dialysis patients.

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Clinicians need to select an appropriate antibacterial agent as soon as possible to stop the rapid progression of Legionella pneumonia. We report the case of a Legionella pneumonia patient who respond well to treatment with pazufloxacin (PZFX) mesilate, a new quinolone antibacterial agent. We treated the patient with PZFX mesilate by intravenous injection twice a day (500 mg/dose) for seven days. Sputum specimens were cultured, and Legionella pneumophila group 1 was detected later. The MIC of PZFX was maintained at 0.015 μg/mL, which is enough to treat Legionella, infection. Because Legionella pneumonia can occasionally becomes exacerbated, the most effectiveantibacterialinjection should be selectedasthe drug offirst choice.The only antibacterial injections approved in Japan for the treatment of Legionella infection are PZFX and minocycline. We conclude that PZFX, which is effective against Legionella, species and has been designed to be transferred to the sputum and lung tissues, is useful and effective in treating Legionella pneumonia.

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