A therapeutic guide to community-acquired pneumoniae is presented in the Manual of Prescriptions for Antibacterial Drugs, edited by the Japanese Association for Infectious Diseases and the Japanese Society of Chemotherapy. Based on this manual and working mainly in general hospitals, we studied the clinical efficacy of cefpodoxime proxetil (CPDX-PR), one of the first-line drugs for ambulatory patients with community-acquired pneumonia categorized as Class I and Class II in the manual, and verified the accuracy of the manual as a therapeutic guide.
Among the 247 subjects assessed for efficacy, CPDX-PR was effective in 3-6 days in 83.1%(133/160) of patients categorized as “excluded indeterminate”. Among the 133 judged as “effective”, we evaluated “cured or improved” in community-acquired pneumonia and found that “cured or improved” was 99.0%(102/103) in 7-10 days in patients categorized as “excluded indeterminate”. In 11 of 27 judged “ineffective”, CPDX-PR was continued or ended without changing prescriptions to other antibacterial drugs. Of these 11, 9 categorized as “excluded indeterminate” were assessed as “cured or improved” in the last treatment assessment. Of the 263 patients assessed in the safety analysis, 1 reported adverse events-mild GOT and increased GPT-, but recovered rapidly after CPDX-PR was discontinued.
We thus confirmed that CPDX-PR is clinically highly effective and safe in the treatment of communityacquired pneumonia, and that criteria for efficacy in the manual were useful in assessing community-acquired pneumonia patients in the early stages of illness. We also found, however, that reconsidering criteria for changing prescriptions to other antibacterial drugs would improve the accuracy of the manual, because some patients among those treated as “ineffective” recovered without changing to other antibacterial drugs.

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A 48-year-old man diagnosed with acute myeloid leukemia in November 1999 and undergoing bone marrow suppression after remission induction chemotherapy suffered fungal pneumonia treated with anti fungal fluconazole (FLCZ). On day 14 of the anti fungal treatment, he suffering from torsades de points, evidenced by a typical ECG pattern sign curve, was compatible with torasades de points. He felt palpitations and unclear conciousness and we found prolonged QT time on ECG and low serum Ca, grtimenormalized when was FLCZ discontinued and was serum Ca was corrected. This very rare disorder is potentially fatal, and long QT time syndrome should be considered in pastients being treated with FLCZ for fungal infection.

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Bacteriological and clinical comparative study were carrid out on azithromycin (AZM) and cefcapene-pivoxil (CFPN-PI).
AMZ was administrated 500 mg once a day for three days, CFPN-PI was 100 mg three times a day for seven days to the patients of acute tonsillitis or acute sinusitis.
As a result, there was no significant difference of efficacy rate between AZM and CFPN.

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Azithromycin (AZM: Zithromac^®) was approved in March 2000 and launched in June 2000 in Japan. A special investigation of Zithromac^® for clinical efficacy evaluation of infectious diseases caused by 6-pathogens was begun to collect and confirm efficacy information on infectious diseases caused by Haemophilus influenzae, Streptococcus pneumoniae, Mycoplasma spp., Chlamydia pneumoniae, Moraxella (Branhamelia) catarrhalis, and Peptostreptococcus spp. In total, 327 patients were analyzed for safety and 307 for efficacy.
In the 307 in efficacy analysis, efficacy was 85.7%(114/133) for respiratory tract infection, 90.7%(107/118) for sinusitis, and 85.7%(48/56) for dental or oral surgery infection.
Efficacy for the commonest causative organisms was 92.1%(93/101) for H. influenzae, 81.5%(75/92) for S. pneumoniae, 94.1%(32/34) for Mycoplasma spp., 90.9%(10/11) for C. pneumoniae, 94.6%(35/37) for M. catarrhalis, and 84.6%(44/52) for Peptostreptococcus spp.
Of the 327 in safety analysis, 11 cases of adverse drug reactions (ADRs) were reported in 11 patients, with an ADR incidence of 3.36%(11/327). No cases of serious ADR were seen.

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