CHEMOTHERAPY
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- かずき たけくま
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2 VOL.40 S-1 coagulase negative Staphylococcus sp, methicillin- resistant Staphylococcus aureus (MRSA), Enterococcus faecalis, Escherichia coli, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Proteus vulgaris, Pseudamonas aeruginosa two-compartment Coagulase negative Staphylococcus sp model C. freundii, K. pneumo-
3 Table 1. MICs of meropenem, ceftazidime and imipenem against urinary isolates (Inculum size: 106 CFU/ml)
4 Fig. 1. Serum and prostate concentrations of meropenem (0.5 g, 30 min D.I.).
5 ND: not done Fig. 2. Serum levels of meropenem following given 0.5g 30-minute drip infusion. Table 2. Pharmacokinetic parameters of meropenem 0.5g D.I. in cases with renal dysfunction * 1st: 1st administration, 10th: 10th administration
6 n=3 Ccr 44.5 } 13.5 ml/mm Fig. 3. Serum levels of meropenem in patients with renal dysfunction. Table 3-1. Clinical summary of uncomplicated UTI patients treated with meropenem AUP: acute uncomplicated pyelonephritis * Before treatment After treatment **UTI: criteria proposed by the Japanese UTI Committee Dr.: Dr.'s evaluation
7 APRIL 1992 Table 3-2. Clinical summary of complicated UTI patients treated with meropenem CCP: chronic complicated pyelonephritis CCC: chronic complicated cystitis VUR: vesico ureteral reflux Rt.: right YLO: yeast-like organism * Before treatment After treatment **UTI: criteria proposed by the Japanese UTI Committee Dr.: Dr.'s evaluation Table 3-3. Clinical summary of acute prostatitis treated with meropenem * Before treatment After treatment **UTI: criteria proposed by the Japanese UTI Committee Dr.: Dr.'s evaluation
8 Table 3-4. Clinical summary of acute epididymitis treated with meropenem * Before treatment After treatment **UTI: criteria proposed by the Japanese UTI Committee Dr.: Dr.'s evaluation Table 3-5. Clinical summary of scrotal abscess patients treated with meropenem Lt.: left * Before treatment After treatment Table 4. Overall clinical efficacy of meropenem in complicated UTI
9 APRIL 1992 Table 5. Overall clinical efficacy of meropenem classified by the type of infection Table 6. Bacteriological response to MEPM in complicated UTI and strains appearing after treatment GNF-GNR: glucose-nonfermenting gram-negative rod YLO: yeast-like organism * regardless of bacteria count
10 1) Tanio T, Nouda H, Tada E, Kohzuki T, Kato M, Fukasawa M, Okuda T, Kamidono S: SM- 7338, a new carbapenem antibiotic: Renal dehydropeptidase- I stability and pharmacokinetics in animals. 27th ICAAC, New York. Abstract no. 758, ) Jones RN, Gardiner PV: Stability of SM-7338 a new carbapenem in mediums recommended for the susceptibility testing of anaerobic bacteria and gonococci. Diagn Microbiol Infect Dis 12: , 1989
11 APRIL 1992 BASIC AND CLINICAL STUDIES OF MEROPENEM IN URINARY TRACT INFECTION Toshihiro Goto, Motoshi Kawahara, Shinichi Makinose, Daishi Yamauchi, Yasuhiko Obama and Yoshitada Ohi Department of Urology (Director: Prof. Y. Ohi), Faculty of Medicine, Kagoshima University Sakuragaoka, Kagoshima 890, Japan Kazuya Kawahara and Shizuo Yagi Division of Urology, Kagoshima Prefectural Ohshima Hospital Shinichi Nagata, Motoaki Odati, Hiroshi Hayami and Tuneyoshi Division of Urology, Saga Prefectural Hospital Kawashima Kazuhiro Nagayama and Akira Imamura Division of Urology, Kushima National Health Insurance Hospital Takeshi Shimada and Toshihiro Kitagawa Division of Urology, Miyakonojo National Hospital Kouichi Otoshi Division of Urology, Kimotsukigun Medical Association Hospital Takashi Kawabata and Morio Nishida Division of Urology, Imakyurei General Hospital The in vitro antimicrobial activity, pharmacodynamics and clinical efficacy of meropenem (MEPM), a new carbapenem, were investigated. The antimicrobial activity of MEPM, imipenem (1PM), and ceftazidime was measured against 30 strains each of coagulase negative staphylococci, methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus faecalis, Escherichia coli, Citrobacter freundii, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Proteus vulgaris and Pseudomonas aeruginosa isolated from patients with urinary tract infection (UTI) at an inoculum size of 106 CFU/ml and measured by the agar dilution method. MEPM was not as active as 1PM against E. faecalis, but it was most active against MRSA and gram-negative bacteria. Prostatic tissue levels were measured 30 minutes after drip infusion of 0.5 g of MEPM in 8 cases who underwent transurethral resection of the prostate. Prostatic tissue per serum level was 16% on average. In the patients with moderately impaired renal function (mean 44.5m1/min of creatinine clearance), the serum levels of MEPM decreased more slowly than those in subjects with normal renal function, but there was no significant difference in pharmacokinetic parameters between the first and fifth days of administration. 0.5g or 1.0g of MEPM was given to 51 cases of UTI. According to the criteria proposed by the Japanese UTI Committee, the overall clinical efficacy in 38 cases of chronic complicated UTI was 92.1%. No adverse reaction was observed in these 51 cases. As abnormal laboratory findings, mild elevation of GOT or GPT was observed in three patients, and transient eosinophilia in one patient.
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