日本化学療法学会雑誌第56巻第S-1号
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- たかとし かみこ
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1 Key words Streptococcus pneumoniae µ µ H F Cl H H N N H N F COOH O Fig.1. Sitafloxacinstructure.
2 I
3 γ S. pneumoniae Haemophilus influenzae
4 Table1. Observationandtestschedule Observation/Tests Informedconsent Patientbackground Symptoms Signs Adverseevent Bodytemperature ParanasalsinusX-ray/CT Bacteriologicaltests Laboratorytests required asneeded Testschedule Before Endof Day3 treatment treatment anytime 7daysafterend oftreatment S. pneumoniae β pbp1a pbpb pbpx pbp1a pbpb pbpx pbp1a pbpb pbp1a pbpx pbp b pbpx pbp1a pbpb pbpx mefa ermb mefa ermb mefa ermb H. influenzae β ftsi β H. influenzae β ftsi β H. influenzae β ftsi γ
5 II
6 Table. Patientprofiles Patients(%) Parameters Otitismedia Paranasal sinusitis Tonsilitis, Pharyngitis, Laryngitis Patientsinanalysis Acuteotitismedia Chronicotitismedia 31(63.3) 18(36.7) 31(6.7) 18(15.5) Diagnosis Acuteparanasalsinusitis Chronicparanasalsinusitis Tonsilitis Peritonsilitis Peritonsilarabscess Pharyngitis,laryngitis Pharyngitis (89.) 5(1.6) 1(5.) 1(5.) 1(5.) 7(35.) 1(5.) (36.) 5(.3) 1(8.6) 1(.9) 1(.9) 7(6.) 1(.9) Severityofilness Moderate Severe 1(8.6) 35(71.) 8(59.6) 19(.) 15(75.) 5(5.) 57(9.1) 59(5.9) Sex Male Female (.9) 7(55.1) 17(36.) 3(63.8) 9(5.) 11(55.) 8(1.) 68(58.6) Age(yrs) 8±16 36±11 3±9 1±15 Bodyweight(kg) 57.5± ± ± ±11.6 Concomitantdrugs No Yes 9(59.) (.8) 3(7.3) 13(7.7) 15(75.) 5(5.) 78(67.) 38(3.8) Table3. Overalclinicaleficacyatendoftreatment Diagnosis Excelent Good Patients(%) Fair Poor Eficacy(%) Otitismedia Paranasalsinusitis Tonsilitis,Pharyngitis, Laryngitis 3(6.9) 7(57.) 1(7.) (.8) 15(31.9) 5(5.) 5(1.) (8.5) 1(5.) 1(.) 1(.1) (55.) (3.5) 1(8.6) (1.7) Eficacy(%)= numberof(excelent+ Good)/numberof 1 Table. Clinicaleficacybydisease Diagnosis Excelent Good Patients(%) Fair Poor Eficacy(%) Otitismedia Acute Chronic (acuteexacerbation) 16(51.6) 7(38.9) 11(35.5) 9(5.) 3(9.7) (11.1) 1(3.) Paranasalsinusitis Acute Chronic (acuteexacerbation) (57.1) 3(6.) 1(33.3) 1(.) 3(7.1) 1(.) 1(.) Eficacy(%)= numberof(excelent+ Good)/numberof 1
7 Table5. Bacteriologicaleficacyatendoftreatment Diagnosis Otitismedia Paranasalsinusitis Tonsilitis,Pharyngitis, Laryngitis Eradication Strains Persistence 5 Eradication(%)= numberoferadication/numberof Eradication (%) Table6. Eradicationbypathogen(otitismedia) Strains Organism Eradication Persistence AerobicGram-positivebacteria 3 S.aureus 8 3 S.pneumoniae 1 AerobicGram-negativebacteria 1 M.(B.)catarhalis H.influenzae 7 P.aeruginosa Eradication(%)= numberoferadication/numberof Eradication (%) Table7. Eradicationbypathogen(paranasalsinusitis) Strains Organism Eradication Persistence AerobicGram-positivebacteria 19 S.aureus 7 S.pneumoniae 1 AerobicGram-negativebacteria 13 M.(B.)catarhalis 3 H.influenzae 1 Anaerobicbacteria P.micros P.oralis 1 P.asaccharolytica 1 36 Eradication(%)= numberoferadication/numberof Eradication (%) S. pneumoniae Staphylococcus aureus H. influenzae Moraxella Branhamella catarrhalis Pseudomonas aeruginosa S. aureus P. aeruginosa S. aureus µ µ µ P. aeruginosa µ µ S. pneumoniae
8 S. aureus H. influenzae MB catarrhalis Peptostreptococcus micros Prevotella oralis Porphyromonas asaccharolytica H. influenzae µ S. aureus Streptococcus pyogenes S. pneumoniae H. influenzae P. micros µ S. pneumoniae µ S. pneumoniae µ S. pneumoniae pbp S. pneumoniae mefa ermb mefa ermb mefa ermb µ ermb µ S. pneumoniae µ µ H. influenzae β ftsi H. influenzae III S. pneumoniae H. influenzae S. pneumoniae mefa ermb H. influenzae S. pneumoniae H. influenzae S. aureus P. aeruginosa S. pneumoniae H. influenzae S. aureus P. aeruginosa S. pneumoniae H. influenzae
9 Table8. ConcentrationofSTFXinmiddleear,maxilarysinus,ethmoidalsinus,palatinetonsil,andserum Mucousmembraneofmiddle ear Mucousmembraneof maxilarysinus Mucousmembraneof ethmoidalsinus Palatinetonsil Dose (mg) Patients median min,max Patients median min,max Patients median min,max Patients median min,max Serum (μ g/ml) 1.59±.8.5.,1.8.58± , ±.38.6., ± ,1. ConcentrationofSTFX Tissue(μ g/g) 9 a).8± , ± , ± , ± ,.93 a) underdetectionlimitsoftissueconcentrationforhighdilutionbyshorttissueweightin1case b) underdetectionlimitsoftissueandserum concentrationin1additionalcase Penetrationratio (tissue/serum) 8 b) 1.± ,.5 1.1±.8.9., ± , ± ,. S. pneumoniae µ H. influenzae µ S. aureus µ µ µ P. aeruginosa µ µ S. aureus µ µ S. pneumoniae H. influenzae µ µ
10 Streptococcus pneumoniae β β Haemophilus influenzae
11
感染症学雑誌第77巻第8号
1 2 µ Streptococcus pneumoniae µ S. pneumoniae µ S. pneumoniae pbp β β pbp1a pbp2x pbp2b pbp mefe ermb pbp pbp1a pbp2x pbp2b pbp pbp pbp pbp 2x pbp1a pbp2x pbp 2b mefe ermb pbp β pbp2x β β β µ µ pbp3 µ
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