MT-141, a new antibiotic of the cephamycin group, was employed in the treatment of internal infectious disease, and clinical efficacy of the drug was investigated. Twenty five patients with infections (Pneumonia 7 cases, RTI 3 cases, UTI 15 cases) were treated with MT-141 at a daily dose of 2 g twice a day by intravenous drip infusion. These patients consisted of 12 males and 13 females, and they ranged in age from 65 to 97 years (mean age: 78.6 years). The MT-141 therapy was continued for 6 to 23 days (mean duration: 10.9 days) and the total dosage ranged from 12 to 45g (mean: 21.6g). The clinical efficacy was evaluated as “good” in 17 cases, “poor” in 6 cases and “fair” in 2 cases. The efficacy rate was thus 68%. Causative organisms were isolated in 14 patients. These organisms were eradicated in 11 patients and replaced by other organisms in 3 patients. As with side effects, skin eruption were observed in 3 cases. The abnormal laboratory test values were recorded in anemia (2 cases) and elevation of eosinophilia (7 cases).
RD cells can use for Neutralizing antibody test of some Group A Coxsackieviruses (Cox.A). The virus isolation rate from clinical specimens was much lower than from the suckling mice methord. We carried out the doming of RD cells and had the clorn cell line named RD-18S sensitive to Cox. A viruses. RD-18S cells were tested for the sensitivity to Enteroviruses and isolation from clinical specimens. The results were as follows. 1) RD-18S cells were sensitive to Cox. A2, 3, 4, 5, 6, 8, 10, 12, 17, 18, 21 and 24 virus and not sensitive to Cox. Al, 19 nor 22 virus. 2) Cytopathic effect (CPE) of RD-18S cells were more clear and sensitive than that of RD cells, especially Cox. A3, 4, 5, 6, 8 and 17 virus. 3) The isolation rate of the Cox. A viruses from clinical specimens was 63.6% in RD-18S and 14.3% in RD cells, compared with that of suckling mice. 4) RD-18S cells were more sensitive than GMK cells to standard ECHO viruses and isolation rate of ECHO viruses from clinical specimens was higher (78.8%) in RD-18S cells than in GMK (40.1%), HEL (70.4%) and HeLa (325.1%) cells.
The results of the Micro TrakTM Chlamydia trachomatis Direct Specimen Test were compared to those Micro TrakTM Culture Confirmation Test after primary culture in clinical investigations. Analysis of 81 samples from genital organs (male urethra, female cervix) with both methods showed that the sensitivity of the direct test was 84.6%(33/39) and the specifity was 97.6%(41/42).Samples with discrepancies between culture results and direct test results tended to have a low number of inclusions or a low mumber of chlamydial organisms. There was no significant difference in Micro TrakTM Chlamydia trachomaits Direct Specimen Test performance between anatomic sites sampled. The Micro TrakTM Chlamydia trachomatis Direct Specimen Test is comparable in performance to conventional cell culture techniques in the detection of C. trachomatis, and also very rapid and easy to perform.
A certain brand of tampons were soaked in each diluted culture of 9 toxic shock toxin (TST)-producing Staphylococcus aureus strains and then incubated at 37° for 18th in flasks where tampons had a large volume of air outside and inside, or in vinyl pouchs where tampons had much less volume of air. Each diluted culture was incubated with shaking or stationarily in control. After incubation cultures were recovered from the tampons. Then viable cell counts and TSTproduction of each culture were estimated. Viable cells per ml were enumerated to be more than 109 in almost all samples and no remarkable difference in viable cells among the samples was observed. TST production in tampons in flasks was shown very high, similar to that of shaking culture (p>0.05) and much more than that in tampons in pouchs at a rate of 47: 1 Then other four brands of tampon were tested by the same method with a TST-producing S. aureus strain and it resulted similarly.These show that TST production of the strains in tampons was much influenced by the volume of air during incubation. It is considerable that tampons have the potentiality to make a state full of air where the strains produce a large amount of TST.
For the purpose of studying on infantile pneumonia caused by Chlamydia trachomatis, 8 infants with nonbacterial pneumonia 2 to 12 weeks of age were examined for serum antibody to C. trachomatis and nasopharyngeal shedding of C. trachomatis. Both IgG and IgM class antibodies to C. trachomatis were detected by micro-immunofluoresence test in 4 out of 8 patients. Direct immunofluorescent staining of nasopharyngeal smears using monoclonal antibody to C. trachomatis were all positive in these4 patients who had both IgG and IgM class antibodies. Two of these patients' mothers also had both IgG and IgM class antibodies. Their immunotypes of antibody had an accordance with their children's immunotypes of antibody. Our data showed that pneumonia in these 4 patients was caused byC. trachomatis. It is suggested that C. trachomatis plays an improtant pathogen of infantile pneumonia in Japan and this infantile pneumonia is derived from maternal C. trachomatis infection. We thought that the detection of IgM class antibody to C. trachomatis is useful in diagnosing chlamydial pneumonia in infants.
This study was aimed to investigate the pathogenicity of Ureaplasma urealyticum and Clostridium difficile in nongonococcal urethritis (NGU) through isolations of these organisms from men with NGU and without urethritis, and therapeutic study as concerns ureaplasmas. The in vitro antimicrobial susceptibility test of ureaplasmas was also done. U. urealyticum was isolated in significance more frequently from men with NGU than from healthy men, but not significantly than from men with gonococcal urethritis (GU). In quantitative study 105 or more color-changing unit (CCU) per ml of ureaplasmas appeared more frequently in men with NGU (24%) than in healthy men (6%). There was the tendency that number of U. urealyticum in specimens would increase with the progressively more number of polymorphonuclear cells in urethral smear. The antimicrobial susceptibility of 58 clinical isolates of U. urealyticum to 10 antimicrobial agents was measured by microtiter-plate method. Although minocycline (MINO) and doxycycline (DOXY) were the most active against ureaplasmas among an -timicrobial agents tested, 5 strains were not inhibited by 12.5μg per ml of both drugs after 3-day culture for final minimal inhibitory concentration (MIC). These strains were inhibited at concentrations of 6.25μg or less per ml of erythromycin after 3-day culture. The entity for an etiological agent of Ureaplasma in NGU was suggested by the selective therapy using MINO and DOXY being active against Ureaplasma and Chlamydia both, and ampicillin, cephalexin and sulfamethizole being not active against Ureaplasma. U. urealyticum seems to be a characteristically opportunistic pathogen, though it is transmitted sexually. There was no evidence to suggest that C. difficile was associated with NGU or urethral syndrome; that is, from none of 44 men including 19 with NGU and none of 18 women with urethral syndrome C. difficile was not isolated.
Trends of tetanus mortality (1947-1982) and case fatality (1940-1982) were investigated based on Vital Statistics of the Ministry of Health & Welfare and clinical records collected by the authors from various sources, respectively. There were 21, 916 fatal cases during 1947-1982. The mortality rate per105 population declined from 2.84 (2221 cases) in 1947 to 0.98 (887 cases) in 1955 and to 0.02 (26 cases) in 1982. The neonatal tetanus mortality per 105 live births made a more rapid decline from 36.1 in 1947 to 0.67 in 1970 and to O in 1979. This rapid decline of neonatal tetanus mortality was inversely related to the increase of babies born at medical institutions instead of at homes. The rapid decline of neonatal tetanus mortality contributed largely to the rapid decline of overall tetanus mortality. The analysis of the fatal cases indicated relative preponderance of aged people among the total cases in recent years. The patients aged 40 years and more occupied 24% in 1950 but they occupied more than 70% in recent years. The decline of mortality in the age group of 0-10 years excluding neonates was related to the general use of DTP vaccine from 1969. There was a conspicuous decline in case fatality from about 40-50% during 1940-1970 to 20 and then to 10% in the following decades. This was attributed to therecent trends of treating tetanus patients in the intensive care units where almost moribund patients destined to die in the past decades have come to be successfully treated employing curarisation and artificial respiration.
The clinical effectiveness, safety and usefulness of sultamicillin tosilate (SBTPC) were compared with those of bacampicillin hydrochloride (BAPC) in patients with respiratory tract infections (RTI) by a double-blind study. RTI included in protocol were pneumonia, lung abscess and chronic RTI (chronic bronchitis, diffuse panbronchiolitis and other chronic RTI). SBTPC tablet (375 mg) or BAPC tablet (250 mg) was administered orally for 14 days at daily dose of 3 tablets, one tablet at a time, to assess clinical effectiveness, bacteriological response, side effects, laboratory findings and clinical usefulness. The following results were obtained: 1) Number of patients: SBTPC and BAPC were administered to a total of 265 patients (134 on SBTPC and 131 on BAPC). Out of this, 33 patients were excluded or dropped out; clinical effectiveness was analyzed statistically in 232 patients (116 on SBTPC and 116 on BAPC). Side effects were evaluated in 256 patients (129 on SBTPC and 127 on BAPC). 2) Clinical effectiveness: Clinical effectiveness rates by the committee judgement was 82.8%(96/116) for SBTPC and 69.8%(81/116) for BAPC, respectively; the statistical analysis revealed that SBTPC was significantly more effective than BAPC. Analysis based on the severity of infections showed that the clinical effectiveness of SBTPC (88.6%) in moderate infections was significantly superior to that of BAPC (65.5%). Furthermore analysis based on diseases showed that the clinical effectiveness of SBTPC (89.2%) in patients with chronic RTI was significantly superior to that of BAPC (63.2%). 3) Bacteriological response: The bacteriological elimination rates of causative organisms was 75.4% for 70 strains treated with SBTPC and 65.2% for 72 strainstreated with BAPC, and the difference was not statistically significant. 4) Time-course improvement of signs and symptoms and laboratory findings: On the 14th day or the final day of treatment, white blood cells count improved significantly more in the SBTPC group than in the BAPC group. Improvements of white blood cells count on the final day in the pneumonia group, of body temperature on the 14th day and on the final day, of sputum property in the 7th day and on the final day, and of white blood cells count on the final day of treatment in the chronic RTI group were superior in the SBTPC to the BAPC group. 5) Side effect: Side effects were observed in 16.3% of 129 patients in the SBTPC group and in 6.3% of 127 patients in the BAPC group. SBTPC produced significantly more side effects than BAPC, but in most cases these side effects were mild and the severity of side effect was not significantly different between the both groups. Incidence of diarrhea observed in the SBTPC group was significantly more than that in the BAPC group, but no severe side effects affecting the prognosis were observed in the both groups. Abnormal laboratory findings, mainly transaminase elevations and eosinophil increase, were not significantly different between the two groups. The severity was mild in all cases except one in the BAPC group who showed a moderate degree of abnormal findings (elevations of GOT, GPT and Al-P). 6) Usefulness: Usefulness rates judged by committee members for the SBTPC group and BAPC group were 77.1% and 66.9%, respectively, and these were not significantly different statistically. But rates of usefulness in the chronic RTI group was 83.6% for the SBTPC group and 61.0% for the BAPC group and the difference was significant. Also in the chronic RTI, usefulness rates judged by doctors in charge were 80.6% for the SBTPC group and 62.3% for the BAPC group, and this difference was statistically significant. From the above results it was concluded that usefulness of SBTPC was significantly superior to that of BAPC, being highly useful agent for the treatment of RTI, especially for chronic RTI.
Multiple oral, doses of sultamicillin, a linked ester of ampcillin and β-lactamase inhibitor, sulbactam, were given to healthy male volunteers and its safety, pharmacokinetics and effects on intestinal flora were investigated. The results are summarized as follows. The subjects enrolled in the study were 10 male healthy volunteers and received an oral dose of 375 mg of sultamicillin twice a day 15 days. Six of them were administered, with an interval of six months, 500 mg of ampcillin by the same method for comparison. As side effects presumably related to the drug administration, two cases, a case in each of the sultamicillin and ampicillin groups, developed transient diarrhea. No specific abnormality was found in the laboratory tests which were performed brfore, during and after treatment. Serum levels and urinary excretion of ampcillin and sulbactam after the initial dosing of sultamicillin were closely alike with each other. As compared with administration of ampcillin alone, the time to reach a peak serum level was shorter and the maximum serum concentrations were higher suggesting a good absorbability of sultamicillin. There was noted, however, no significant difference in the half-life between the two drugs. After sultamicillin was administered, more than 60% of the given dose of both ampcillin and sulbactam were excreted, showing about three times as high recovery rate as that attained as administered ampcillin alone. There was observed no significant difference in the serum levels and urinary excretion between days of 1, 8 and 15 of drug administration. The changes in intestinal flora were minimal in either case of sultamicillin or ampicillin administration and the only change commonly observed in both cases was an increase of candida species. In two cases, one in each of the sultamicillin and ampicillin groups, a slight decrease of anerobes was observed but this change returned to the pre-treatment conditions on the 9th day after completion of drug administration.
Forphenicinol is a low molecular immunomodulator found by Umezawa in Japan from Acti nomyces products. Immunoactivating effects of this drug appears in vitro and in vivo, connecting to alkalinephosphatase on the surface of various cells. Pharmakokinetics and protective effects against bacterial in-fections were made clearly. We administered forphenicinol to 15 patients with chronic respiratory tract infections. Clinical effects were observed in 9 cases. Six of them (4 chronic bronchiolitis do called diffuse pan-bronchiolitis in Japan, 1 bronchiectasis, 1 bronchitis) had pseudomonase infections. In these cases phagocytic activity of neutrophils and number of macrophages in sputum increased. In three cases, forphenicinol had been given about one year to investigate the protective effect against recurrent bacterial infections in doses ranging 50-100 mg every other day. Clinical observation and treatment was done in the same condition before and after forphenicinol by the same doctor. Quantitative culture of sputum was examined two or three times a week. In two chronic bronchitis number of infectious episodes with various bacteria such as the, H. influenzae, S. pneumoniae and B. catarrhalis decreased after administration of forphenicinol. One patient of chronic bronchitis had a longer remission period of about seven months. The other had 0.42 infections episode per month after treatment comparing 0.83 episode per month before that. But in the patient of diffuse pan-bronchiolitis with recurrent staphylococcal infection, number of infectious episodes didn't reduce and moreover other causative bacteria appeared after forphenicinol treatment. From these results, forphenicinol is expected to be useful for pseudomonas infecti on and recurrent bacterial infections with H. influenzae, S. pneumoniae and B. catarrhalis of lower respiratory tract.