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1 ) ) UTI ( )UTI ( 3 )Chemotherapy (Tokyo) ) () ) ) ) Chemotherapy (Tokyo) ) Imipenem/Cilastatin sodium (MK-0787/MK-0791) Chemotherapy (Tokyo) : ) Meropenem Chemotherapy (Tokyo) 1992; ) Meropenem Chemotherapy (Tokyo) 1992 ; ) Imipenem/Cilastatin sodium (MK- 0787/MK-0791) Chemotherapy (Tokyo) ) Panipenem/Betamipron Jpn J antibiotics ) Meropenem Jpn J Antibiotics ) Panipenem/betamipron (CS-976) ) Meropenem Chemotherapy (Tokyo) ) Panipenem/Betamipron Jpn J Antibiotics ) Meropenem Chemotherapy (Tokyo) ) panipenem/betamipron Chemotherapy (Tokyo)

2 ) Meropenem Chemotherapy (Tokyo) ) panipenem/betamipron Chemotherapy (Tokyo) ) Meropenem Chemotherapy (Tokyo) ) Meropenem Chemotherapy (Tokyo) ) Imipenem/Cilastatin sodium (MK-0787/MK-0791) Chemotherapy (Tokyo) ) MK-0787/MK-0791 Piperacillin ) panipenem/betamipron imipenem/cilastatin Chemotherapy (Tokyo) ) panipenem/betamipron imipenem/cilastatin Chemotherapy (Tokyo) ) meropenem imipenem/cilastatin sodium Chemotherapy (Tokyo) ) meropenem imipenem/cilastatin sodium Chemotherapy (Tokyo) ) biapenem imipenem/cilastatin ) biapenem imipenem/cilastatin ) biapenem imipenem/cilastatin ) 2)

3 2.7 32) 1) ) UTI ( )UTI ( 3 ) Chemotherapy (Tokyo) ) Meropenem ) Meropenem ) ) Knaus WA, Draper EA, Wagner DP, Zimmerman JEAPACHEA severity of disease classification systemcritical Care Medicine ) Cometta A, Baumgartner JD, Lew D, Zimmerli W, Pittet D, Chopart P et alprospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patientsantimicrob Agents Chemother 1994June ) Beaucaire GClinical activity of cefepime in severe infectionsclin Microbiol Infect S6-S14 40) M.P.Fink, D.R.Snydman, M.S.Niderman, K.V.Leeper,Jr., R.H.Johnson, S.O.Heard et al. Treatment of severe pneumonia in hospitalized patients: Results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. Antimicrob. Agents Chemother ) F.A.Lerma, on behalf of the serious infection study group. Efficacy of meropenem as monotherapy in the treatment of ventilator-associated pneumonia. J. Chemother ; 13 : ) 2002

4 Report ( 1) R mg 50 mg125 mg 250 mg500 mg R mg 250 mg500 mg 1000 mg R mg 1 2 R mg 1 2 R mg mg 1 3 Report Report (11 ) 6 (11 ) 1 (3 ) Report Report Report05 R142G R142H R143P R143Q R143S ( ) ( ) ( ) ( ) ( ) ( ) ( ) R143T R143V R143W ( ) mg500 mg mg mg mg mg mg mg mg Report Report Report Report Report Report Report13

5 ( 2) Report03Report06 R1415 R1418 R1416 R142R R142U R143R R143U R142A R142C ( ) ( ) R142D ( ) mg mg mg mg500 mg mg500 mg mg 1 2 (MEPM) 500 mg mg 1 2 (MEPM) 500 mg Report mg mg mg mg mg mg mg mg mg mg Report Report Report Report Report Report Report07

6 ( 3) Report16 R142E ( ) R142F R143J R143K R143L R143M ( ) ( ) ( ) ( ) ( ) R143N ( ) R143E ( ) R143A [ ( )] R1431 ( ) mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg ( 28 ) Report Report Report Report Report Report Report Report Report17

7 () Report mg () LD mg/kg 1/600 () mg/kg 1/ mg 1/ DRPM ( mg60 ) mg 2 ( kg) DRPM DRPM mg 1 1 (60 ) (250 mg) (500 mg) ( ) ( ) (ASTALTAl-PLAPLDHγ-GTP A/G TTTZTTBUN NaKClCaPβ 2 -) (α 1 -β 2 -NAGNa KClpH ) ( ) () () * 19 () 19 () *

8 (hr) DRPM (60 ) 12 ph a) b) c) d) (60 ) a) 500 mg b) 125 mg250 mg500 mg c) 2(810hr1012hr) d) 12 (1224hr)

9 2.7 1) () 1 () ) 10 ALT 1 7 DRPM 3) DRPM 25 mg50 mg125 mg250 mg500 mg ( 2 ) 60 Cmax AUC 2- t 1/2 (β) 1 70%( ) 4) 500 mg DRPM TLC- DRPM

10 2.7 5) 250 mg 1 1 ALT DRPM 7 DRPM 500 mg Cmax AUC DRPM 70% DRPM ( )

11 () Report DRPM mg ( mg30 ) mg 6 ( kg) DRPM DRPM mg 1 1 (30 ) (250 mg) (500 mg) ( ) ( ) (ASTALTAl-PLAPLDHγ-GTP A/G TTTZTTBUN NaKClCaPβ 2 -) (α 1 -β 2 -NAGNa KClpH ) ( ) () () * 19 () 19 () *

12 (hr) DRPM (30 ) 12 ph a) 24hr b) c) DRPM (30 ) a) 500 mg1000 mg b) 2 (810hr1012hr) c)12 (1224hr)

13 2.7 1) () 1 () ) 24 3 (γ-gtp AST ) DRPM 3) DRPM mg 30 Cmax AUC t 1/2 (β) 24 DRPM 1000 mg 24 DRPM 75%DRPM (DRPM-DC) 90% ( ) 4) DRPM 1000 mg DRPM TLC-

14 2.7 DRPM 5) DRPM DRPM-DC HPLC 24 () 125 mg 12.7%250 mg 12.1%500 mg 15.5%1000 mg 17.2% ( ) DRPM-DC AUC AUC 250 mg 4%500 mg 6%1000 mg 7% 125 mg DRPM-DC DRPM-DC Cmax Cmax 250 mg 3% 500 mg 3% 1000 mg 4%DRPM DRPM-DC 24 90% ( ) 6) ex vivo % ( ) 7) DRPM 1000 mg Cmax AUC 125 mg 1000 mg () 125 mg 1000 mg 24 75% DRPM DRPM-DC AUC AUC 250 mg 4%500 mg 6%1000 mg 7%DRPM-DC Cmax Cmax 250 mg 3% 500 mg 3% 1000 mg 4% (DRPM) DRPM-DC 90% mg ( 30 2 ) % DRPM mg 125 mg 1000 mg

15 () Report DRPM500 mg ( ) (1 500 mg ) 8 ( 2 ) ( kg) DRPM DRPM 500 mg 1 2 (30 ) 6 (11 ) ( ) ( ) (ASTALTAl-PLAPLDHγ-GTP A/G TTTZTTBUN NaKClCaPβ 2 -) (α 1 -β 2 -NAGNa KClpH )( ) () () () * 19 () 19 () *

16 DRPM (30 ) 12 ph () DRPM (30 ) *

17 1) () 1 () ) DRPM 500 mg ( 11 ) (30 ) DRPM 1 () DRPM 3) DRPM DRPM EnterobacteriaceaeLactobacillus Streptococcus Enterococcus 7 C. difficile DRPM 1 4

18 () No. of aerobes (log CFU/g of feces) Isolate Enterobacteriaceae GNF-GNR a) Streptococcus Enterococcus Staphylococcus Bacillus Yeasts Lactobacillus 7.1 ND b) ND ND ND Total aerobes a) b)not detected () No. of anaerobes (log CFU/g of feces) Isolate Bacteroides Fusobacterium Bifidobacterium Eubacterium Lactobacillus Clostridium Peptococcaceae Veillonellaceae ND a) Total anaerobes a)not detected 4) DRPM DRPM Streptococcus HaemophilusNeisseriaceae Bacteroides FusobacteriumActinomycesStreptococcusVeillonella 3 6

19 () Isolate Enterobacteriaceae GNF-GNR c) Haemophilus Streptococcus Staphylococcus Neisseriaceae Bacillus Corynebacterium Yeast Lactobacillus ND b) ND a) ND ND No. of aerobes (log CFU/swab) 3 ND ND ND ND ND 1.2 ND ND ND ND ND ND 4.5 ND 3.0 Total aerobes a) b)not detected c) () Bacteroides Fusobacterium Actinomyces Bifidobacterium Propionibacterium Eubacterium Peptostreptococcus Streptococcus Veillonella Isolate ND b) No. of anaerobes (log CFU/swab) a) ND ND ND ND ND ND 3.7 ND ND ND Total anaerobes a) b)not detected 5) DRPM 500 mg ( ) 30 DRPM ( ) 6) 500 mg % ( )

20 7) β- 3 1 DRPM DRPM (0.15 µg/g) ( ) β ( ) DRPM Fecal concentraions (µg/g) Before Day 3 Day 7 ( 1 ) 1 <0.15 <0.15 < <0.15 <0.15 < <0.15 <0.15 < <0.15 <0.15 < a) <0.15 <0.15 < <0.15 <0.15 < a) <0.15 <0.15 < <0.15 <0.15 <0.15 a)placebo DRPM β lactamase β lactamase activity Before Day 3 Day 7 ( 1 ) a) a) ) β lactamase Nitrocefin (2E-n) a)placebo 8) Cmax 12 DRPM 2

21 () Report DRPM1000 mg ( mg ) 8 ( 2 ) ( kg) DRPM DRPM 1000 mg 1 2 (30 ) 6 (11 ) (500 mg) () ( ) ( ) (ASTALTAl-PLAPLDHγ-GTP A/G TTTZTTBUN NaKClCaPβ 2 -) (α 1 -β 2 -NAGNa KClpH ) (CRP ) () * 19 () 19 () *

22 DRPM CRP ph () () β

23 1) () 2 () ) DRPM 1 DRPM DRPM AST ALT 1 ALT 1 ALT LDH 1 3 DRPM DRPM DRPM

24 3) DRPM Enterobacteriaceae Enterococcus 7 BacteroidesBifidobacterium C. difficile DRPM mg 1 2 4) DRPM 1000 mg ( ) 30 DRPM ( ) 5) 1000 mg % ( ) 6) β- DRPM ( 34 ) ( 67 ) (0.15 µg/g) β- 7) DRPM ( mg 1 2 )

25 (500 mg 3 ) Report DRPM mg DRPM (1 500 mg ) 6 ( kg) DRPM DRPM 500 mg 1 3 (30 ) 3 (500 mg) () () ( ) (ASTALTAl-PLAPLDHγ-GTP BUNNaKCl) ( )(CRP) () * 20 () 20 () *

26 2 1 1 () 1 7 () () )

27 () ) DRPM 500 mg 1 3 (6 3 ) 30 () () DRPM ( ) 3) 2 ( 4 ) DRPM 1 [ ()] 4) 1 3 DRPM

28 () Report DRPM 2 ( 250 mg 500 mg3060 ) () 13 () 12 1) ) 2) 3) β- 4) 5) DRPM 6) 6 7) DRPM DRPM mg () 500 mg () (3060 ) 250 mg 500 mg 1) 2) 3) 4) DRPM 1 2 Bioassay 1) 5) ()

29 () () 6) () * 4 19 () 19 () * 1) ( ) 1 () ( 1) () ( 1) () ( 1 1)

30 2.7 2) 項目カテゴリー例数 性 13 年齢 () 69.9 () 4.9 () 61.0 () 72.0 () 75.0 体重 40 kg 50 kg 1 50 kg 60 kg 6 60 kg 70 kg 6 (kg) 59.2 (kg) 6.3 (kg) 46.0 (kg) 59.0 (kg) 69.5 性 13 入院 外来の区分 13 0 基礎疾患の有無 11 2 合併症の有無 13 0 治験薬投与直前の化学療法の有無 ) DRPM 250 mg µg/g (8 ) µg/ml (8 ) % % (7 ) DRPM 500 mg µg/g (5 ) µg/ml (5 ) % (5 ) ( ) 4) A) () () 13 1 () 250 mg 8 500

31 2.7 mg 5 13 B) () () 12 2 () mg mg ( 25.0%)10 () 250 mg 1 ( 8.3%)4 () AST ALT γ-gtp β 2 5) DRPM 250 mg 500 mg )

32 () Report DRPM ( 250 mg30 ) 13 (10 3 ) () 13 () ) 2) () 1) 2) β- 3) 4) 5) 6) 6 (DRPM ) 7) (HIV) 8) () DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1) ) () Bioassay

33 () () 1) 5) () 6) () * 19 () 19 () * 1) 13 ( ) () 13 ()

34 2.7 2) () 52.0 () 10.5 () 37.0 () 50.0 () kg 50 kg 3 50 kg 60 kg 6 60 kg 70 kg 4 (kg) 54.7 (kg) 7.6 (kg) 40.0 (kg) 56.0 (kg) 65.0 入院 外来の区分 ) DRPM 250 mg ( 8 ) µg/g (7 ) µg/g (7 ) µg/g (7 ) µg/g (8 ) µg/g (7 ) µg/g (7 ) () µg/ml (10 ) () % (7 ) % (7 ) % (7 ) % (8 ) % (7 ) % (7 )

35 2.7 () 1 µg/ml µg/ml (10 ) () % (10 ) ( ) DRPM 250 mg 30 (3 ) µg/ml 1 (Cmax) µg/ml ( ) %( ) 4) A) () 13 B) () 13 5) DRPM 250 mg )

36 () Report DRPM ( 250 mg30 ) () 10 () 10 () () 1) ) 3) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1 2 Bioassay 1) 5)

37 () () 12 3 () 6) () * 5 20 () 20 () * 1) ( ) () () () () () ()

38 2.7 2) 項目 カテゴリー 例数 性 男 4 女 6 年齢 30 歳以上 40 歳未満 () 64.7 () 16.1 () 35.0 () 69.0 () 79.0 体重 40 kg 1 40 kg50 kg 1 50 kg60 kg 4 60 kg70 kg 4 (kg) 56.3 (kg) 9.7 (kg) 38.5 (kg) 57.5 (kg) 68.0 入院 外来の区分 入院 10 外来 0 基礎疾患 合併症の有無 無 7 有 3 7 無 10 有 0 3) DRPM 250 mg µg/ml (7 ) µg/g (9 ) µg/g (8 ) µg/g (4 ) µg/ml (9 ) 26.5% (1 ) % (5 ) % (5 ) % (3 ) 1 ( )

39 2.7 4) () () 10 1 A) () 10 3 (30.0%)6 3 1 () B) () 10 6 ( 60.0%)13 AST ALT () 5) DRPM 250 mg )

40 () Report DRPM ( 250 mg30 ) () 12 () 12 1) ) 3) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1 2 Bioassay

41 () () 1) 5) () 6) () * 4 20 () 20 () * 1) 12 ( ) () 12 ()

42 2.7 2) () 42.1 () 14.3 () 21.0 () 40.0 () kg 1 40kg50kg 1 50kg60kg 3 60kg70kg 4 70kg 2 1 (kg) 62.7 (kg) 15.7 (kg) 38.0 (kg) 61.7 (kg) 93.6 入院 外来の区分 ) DRPM 250 mg µg/g (5) µg/ml (6 ) % (5 ) µg/g (6 ) µg/ml (6 ) % (6 ) ( ) 4) A) () 12 1 (8.3%)1 ()

43 2.7 () B) () 12 5) DRPM 250 mg )

44 () Report DRPM ( 250 mg30 ) () 10 () 10 1) ) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1 2 Bioassay HPLC

45 () () 1) 5) () 6) () * 20 () 20 () * 1) 10 ( ) () 10 ()

46 2.7 2) () 35.9 () 14.2 () 22.0 () 31.5 () kg 70kg 2 70kg 80kg 1 7 (kg) 65.7 (kg) 8.1 (kg) 60.0 (kg) 62.0 (kg) 75.0 入院 外来の区分 ) DRPM 250 mg µg/g (7 ) µg/ml (10 ) % (7 ) ( ) 4) A) () 10 B) () 10 2 ( 20.0%)2

47 2.7 () BUN () 5) DRPM 250 mg )

48 () Report DRPM () ( 250 mg30 ) () 5 () 5 1) ) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 12 Bioassay 1) 5)

49 () () * 12 3 () 6) () 20 () 20 () * 1) 5 ( ) () 5 ()

50 2.7 2) () 67.4 () 9.8 () 52.0 () 70.0 () kg 50kg 1 50kg 60kg 3 60kg 70kg 1 (kg) 56.3 (kg) 5.1 (kg) 49.5 (kg) 56.0 (kg) 63.0 入院 外来の区分 ) DRPM 250 mg µg/ml (5 ) µg/ml (5 ) % (4 ) ( ) 4) A) () 5 1 (20.0%)1 () B) () 5 2 ( 40.0%)2

51 2.7 () 5) DRPM 250 mg )

52 () Report DRPM ( 250 mg30 ) () 10 () 10 () 1) ) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1 2 Bioassay

53 () () 1) 5) () 6) () * 20 () 20 () * 1) 10 ( ) () 10 ()

54 2.7 2) () 29.7 () 9.6 () 20.0 () 26.5 () kg50kg 4 50kg60kg 3 60kg70kg 3 (kg) 53.3 (kg) 9.6 (kg) 40.0 (kg) 51.5 (kg) 68.0 入院 外来の区分 ) DRPM 250 mg µg/g (7 ) µg/ml (6 ) % (6 ) µg/g (3 ) µg/ml (3 ) % (3 ) ( ) 4) A) () 10 B) () 10 4 ( 40.0%)4

55 2.7 () 3 ( 30.0%) ) DRPM 250 mg )

56 () Report DRPM ( 250 mg30 ) () 5 () 3 1) ) 3) 1) AST 100 IU/L ALT 100 IU/L 2) 3) 4) β- 5) 6) 7) DRPM 8) 6 9) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 30 ( ) HPLC 1) 5) ()

57 () () 6) () * 2 20 () 20 () * 1) 6 1 ( ) () 5 () ( 1 1)

58 2.7 2) () 59.4 () 15.1 () 38.0 () 63.0 () kg 1 40kg 50kg 1 50kg 60kg 2 60kg 70kg 0 70kg 80kg 1 (kg) 53.8 (kg) 13.5 (kg) 37.0 (kg) 53.0 (kg) 73.0 入院 外来の区分 ) DRPM 250 mg µg/ml (5 ) ( Cmax) µg/ml (5 ) ( ) % (5 ) ( ) 4) A) () 5 B) () () (4 )

59 2.7 AST ALT 1 () 5) DRPM 250 mg )

60 Report DRPM mg ( 250 mg30 ) 6 65 ( kg) DRPM DRPM 250 mg 1 1 (30 ) 250 mg () ( ) (ASTALTAl-PLAPLDHγ-GTP BUNNaKCl ( ) (CRP) () * 20 () 20 () *

61 2.7 () (hr) a) a) b) c) b) 0.5 a)b)c) )

62 2.7 7 () 1 () ) ( 250 mg) ( ) 3) 1 4 () 1 () 12 4) DRPM 8 4 ( ) 1 () 12 ()

63 Report DRPM () 12 () 12 1) ) 3) 4) 70 ml/min 1) 2) 3) 4) 5) β- 6) 7) 8) DRPM 9) 6 10) DRPM DRPM mg () (30 ) 250 mg 1) 2) 3) 4) 1) 30 () ) () Bioassay HPLC 1) 5) 3 5

64 () () * () 6) () 1) AUCCmaxt 1/2 2) 20 () 20 () * 1) 12 ( ) () 12 ()

65 2.7 2) DRPM ( 250 mg) (CLcr) AUC ( ) 3) 8.3% (1/12 ) 1 4) DRPM 250 mg DRPM DRPM 250 mg

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