A total of 482 microbial strains were isolated from obliterative abscesses in 240 patients with suppurative inflammation of the oral cavity seen in 11 hospitals nationwide. Their species were identified and their antibiotic susceptibilities were assessed.
1) The proportions of aerobes to anaerobes were 68.0% to 31.5% respectively.
2) The aerobes consisted predominantly of a-Streptococcus. They also included β-Streptococcus, Staphylococcus epidermidis and many other species. Only four strains of S. aureus were found. The anaerobes consisted largely of Bacteroides and Peptostreptococci.
3) The pattern of bacterial distribution did not differ among periodontitis, pericoronitis and ostitis of the jaw.
4) The minimum inhibitory concentration was measured for rokitamycin (TMS-19-Q), josamycin (JM), midecamycin (MDM), erythromycin (EM), ampicillin (ABPC), and cephalexin (CEX) .
5) Erythromycin, rokitamycin and ampicillin demonstrated high sensitivity to the isolated microorganisms. However, Bacteroides tended to acquire resistance to ampicillin. Cephalexin had low sensitivity to the intraoral microorganisms in general.

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A case of acute hemorrhagic colitis following administration of amoxicillin is presented.
A 65-year-old male was prescribed amoxicillin for preventing postoperative infection after alveoplasty of the maxillary ridge. After three days of administration, he suffered from lower abdominal pain and loose stools followed by bloody diarrhea. Colonoscopy showed the bleeding and erosion of the mucosa of the sigmoid colon. Bacteriological examination of patient's the stool revealed Klebsiella oxytoca.
According to these findings, it was diagnosed as acute hemorrhagic colitis due to amoxicillin.

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Culturing techniques for identifying specific microbes have improved immensely with the development of clinical science. However, isolation of the specific organisms responsible for the infection cannot always be accomplished because specimens sent for laboratory analysis are sometimes contaminated or extinct. Great care must be taken especially in the sampling of the pus. The most commonly used methods are needle aspiration and swab methods. In the oral cavity, where the microbial flora is so varied, access can be difficult in taking a sample.
We have devised a new method using the capillary tube commonly used in hematocrit counts. The capillary tube method has the following advantages : it is easy to handle, is adequate to examine even a small quantity of specimen, the specimen can be stored for a long time without alteration of its properties, and it's less expensive than other methods.
We have done some experiments with the capillary tube method investigating its ability to preserve various types of microbial strains including S. aureus, S. epidermidis, Str. milleri, Str. sanguis, Peptostreptococcus sp., B. fragilis, C. welchii, Propionibacterium sp., and Capnocytofaga. The results were shown to be excellent.

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Four hundred fourteen strains of bacteria were isolated from 194 patients with acute odontogenic infection. The cases were divided into 3 groups-pure cultures (66 cases), mixed cultures with two organisms (64 cases), and mixed cultures with 3-6 organisms (64 cases) . The changes of the isolated strains among these 3 groups were studied.
In pure cultures α-Streptococcus was the most common isolate (30.3% of the strains) . Bacteroides was the second (24.2%), and Peptostreptococcus was the third (18.2%) . In mixed cultures with 2 organisms Bacteroides (31.2%) and α-Streptococcus (31.2%) were primarily isolated. In mixed cultures with 3-6 organisms Bacteroides (23.0%), α-Streptococcus (14.5%), Actinomyces (10.4%), Fusobacterium (11.3%) and Peptostreptoccccus (9.5%) were dominant, α-Streptococcus and Peptostreptococcus were isolated more frequently in pure cultures than in mixed cultures with 3-6 organisms. On the contrary, Actinomyces and Fusobacterium were more frequently isolated in mixed cultures with 3-6 organisms than in pure cultures.

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The correlation between the clinical course and isolated organisms in 174 cases of the odontogenic infection was studied. One hundred seventy-four cases were expediently divided into two groups by clinical features and courses. These were (1) acute inflammation type, and (2) chronic inflammation type.
Two hundred eighty-six strains were isolated from pus in 132 cases of the acute inflammation type. They mainly consisted of Bacteroides (84 strains), Streptococcus (31 strains) and Peptostreptococcus (31 strains) . On the contrary, out of 80 strains in 40 cases of the chronic inflammation type, 29 of Bacteroides, 16 of Streptococcus and 14 of Actinomyces were isolated. Bacteroides equally affected both of acute and chronic inflammation types. Streptococcus and Peptostreptococcus were found to be more dominant in acute inflammation type than in chronic inflammation type. Actinomyces was more dominant in chronic inflammation type. It is thought that the causative organisms are different at the stage when dental infection occurs.

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Statistics of the isolated organisms were observed as the oral infections treated at the department of dental and oral surgery in Toyohashi City Hospital in recent 7 years. Samples were gathered by means of needle aspiration from the closed abscesses.
Isolated organisms were total 1, 082 strains out of 823 cases. There were microaerophilic Streptococcus 442 cases (53.7%), α-Streptococcus 175 cases (21.3%), anaerobic bacteria 399 cases (48.5%) and others 66 cases (8.0%) .
We also reported two cases of the liver or pulmonary abscess suspected focal infection from that of chronic dental infections. Streptococcus anginosus was isolated from each abscess.

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Isolates from obstructive abscesses were roughly classified and characterized. Anaerobes were isolated at a slightly greater rate than aerobes.
1) Of the ten species most frequently isolated singly, six were gram-positive and four were gram-negative species. The top four were all gram-positive.
2) Many of the species detected from polymicrobial infection cases were prevalent species which form the so-called “established normal flora.”
3) A study over years of bacterial sensitivity to antibiotics showed a trend of increasing in macrolide-resistance in some species and, during and after 1985, the development of methicillin-resistant Staphylococcus aureus.

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The infections in the oral cavity have been extensively observed in patients with the paradontitis including dental caries. Most of them are infected with the normal flora of the mouth. Disruption of the ecological balance of normal flora is a great factor leading to endogenic infections, and in these cases anaerobic bacteria play a big role. As anaerobic bacteria inhibit the oral cavity as part of the normal flora, they are very likely to be involved in suppurative inflammation in the oral surgery section. In the present study, anaerobic bacteria which were isolated from various cases of oral cavity infection over past decades were analyzed.
One thousand five hundred sixty cases of suppurative disease in the oral cavity were examined. The detection rate of bacteria alone was 95.5%. The rates of infection caused by anaerobic bacteria were 24.9% and 26.7% for gingival abscess and jaw bone osteomyelitis respectively, which were commonly observed in patients in the oral surgery section. In secondary infections of oral cancer, the rate of infection caused by anaerobic bacteria alone was 43.1%, indicating a very high detection rate. The rate of mixed infections caused by both anaerobic and aerobic bacteria in gingival abscess, infectious root canal, paradontitis, odontogenic sinuitis, and jaw bone osteomyelitis was more than 50%, indicating a high rate. In secondary infections for dental inflammation of the maxillary sinus and paradontitis, the rate of mixed infections were 69.7% and 71.7%, showing extremely high rate. Regarding various other inflammatory diseases, besides these infections caused by anaerobic bacteria alone, mixed infections were observed to be caused by several up to 8 kinds of bacteria. For example some of the gingival abscesses and the paradontitis were caused by 8 kinds of bacteria. Anaerobic bacteria were involved in almost all of the mixed infections as well as in many single infections. In the above mixed and single infections, Streptococcus sp., Staphylococcus sp., and Corynebacterium sp, were detected as predominant pathogenic aerobic bacteria, and Veillonella sp. as the predominant pathogenic bacteria. Bacteroides sp., Peptococcus sp. and Fusobacterium sp, were extensively found as pathogenic anaerobic bacteria followed by Veillonella sp.
CER showed a broad spectrum of antibacterial activity against gram-positive and gramnegative, aerobic, and anaerobic bacteria.
Since anaerobic bacteria are often to be responsible for the infections in the oral cavity area, the normal oral cavity flora have to be taken into consideration when treating oral cavity infections.

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Therapeutic drug monitoring (TDM) was first introduced for the purpose of controlling the blood concentration of aminoglycoside antimicrobial agents below a toxic level. At present, it is also utilized for monitoring whether or not the blood concentration of a drug administered reaches its therapeutic level. Precise, rapid and simple methods for assaying drug concentration are indispensable for the effective application of TDM. Reliable definition of pharmacokinetics is also important.
Determination of intracorporeal concentration of antimicrobial agents has been achieved by immunoassay (radioimmunoassay and enzyme immunoassay) in addition to conventional bioassay techniques. High performance liquid chromatography is desirable for drugs that produce metabolites in the body. Although the blood level of a drug represents an intra-corporeal concentration, it can also be estimated from the penetration of the drug into the saliva for many drugs. Measurement of drug distribution in tissues and organs is carried out as a common practice using small animals to estimate drug distribution in man. For correct estimation, establishment of a reliable pharmacokinetic model is prerequisite. In studies of pharmacokinetics, due to the advancement and wide-spread use of computers during these last 10 years, a computerized method of calculating pharmacokinetic parameters based on a compartmental model has replaced conventional determination of parameters, including the half-life from graphically arranged data. If reliable parameters are formulated on the basis of amassed data including blood or tissue-drug concentrations through a great many repeated experiments, they will no doubt greatly contribute to the effective application of TDM by appropriate pre-planning of doses to be administered without going through time-consuming pre-TDM calculations. Although methods of pharmacokinetics are already established, a method for accurate estimation of tissue distribution of drugs in man drawn from measurements made in small animals still remains to be established. We have reached a stage of proposing a tentative plan for formulating patterns of a simulation curve for tissuedrug migration in man.

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