小児感染免疫第25巻第2号

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1 Vol. 25No , TFLX 9 TFLX 450 mg16.6 mgkg TFLX 30 kg TFLX TFLX ,4 TFLX TFLX 450 mg150 mg mgkg cm0.1 S.D kg0.8 S.D Key words

2 WBC 16,300l NSeg 84 Eos 0 Lym 13 RBC 486 l Hb 12.9 gdl Ht 38.9 TP 7.5 gdl Alb 4.1 gdl GOT 25 IUl GPT 15 IUl LDH 251 IUl CPK 167 IUl TBil 0.4 mgdl CRP 0.13 mgdl AMY 99 IUl BUN Cre Na K Cl Ca Glu IgG IgA IgM C3 C4 CH50 ANA ASO 16.7 mgdl 0.61 mgdl 141 meql 4.2 meql 103 meql 9.4 mgdl 135 mgdl 919 mgdl 196 mgdl 184 mgdl 95.8 mgdl 20.6 mgdl 42.4ml IUml ph $ RBC WBC 2 MG NAG CaCre HF 59HF 1HF 14HF 92.1gl 4.7 Ug. Cre CRP Cr0.61 mgdl 1 TFLX CT 2 Cr 1.02 mgdl 32 TFLX 150 mg mg TFLX TFLX Cr TFLX gml gml TFLX 24 1 TFLX TFLX mg mgkg mg 5 27 kg 324 mg

3 Vol. 25No l l 1 TFLX 3 TFLX 2 CT 86.5 mm50.6 mm89.5 mm47.2 mm mg16.6 mgkg TFLX 2.763gml TFLX 12 mgkg Cmax0.96gml 6 Tmax Cmax 2

4 TFLX mg 450 mgday 300 mgday 450 mgday mgkg 2 Cmax 4gml 8 12 mgkg TFLX 8 30 kg 30 kg TFLX TFLX 235 Cmax 1 TFLX 3 2,9, CT TFLX NAG 2 3,10 2 mlkg CT TFLX 2 TFLX

5 Vol. 25No Tosufloxacin 10 58S $ Tosfuloxacin tosilate hydrate 58S Tosfuloxacin tosilate. The Japanese Journal of Antibiotics XLIII , tosufloxacin 58S Okada H, et alan unusual form of crysltalforming chronic interstitial nephritis following long term exposure to tosfuloxacin tosilate. Am J Kidney Dis , T3262 CHEMOTHERAPY 36 S , 1988 A case of renal dysfunction caused by an overdose of tosufloxacin tosilate Mariko MATSUMURA 1,2, Yuka IKEUCHI 1, Chikage YOSHIZAWA 1, Yasuo SUNAGA 1, Masahiko TASHIRO 1, Yasuko KOBAYASHI 2, Takumi TAKIZAWA 2, Hirokazu ARAKAWA 2 1Department of Pediatrics, Gunma Central Hospital 2Department of Pediatrics, Gunma University Graduate School of Medicine A 9yearold boy presented with renal dysfunction 32 hours after an overdose16.6 mg kgdayof tosufloxacin tosilatetflx, prescribed as treatment for knee and elbow abrasions that he sustained after falling off a bicycle. He presented to our emergency department with vomiting, abdominal pain, and back pain with costovertebral tenderness. Proteinuria, hematuria, and a slightly elevated serum creatinine level were observed. Contrastenhanced computed tomographyctshowed enlargement of both the kidneys, and excretory phase CT revealed filling defects at several sites in the renal medulla. The serum TFLX concentration was extremely high2.763gmlat admissioni.e., 8 hours after the last oral administration of TFLX. After admission, intravenous fluid therapy alone was administered. The patient s symptoms were alleviated within 3 days of admission, and the serum TFLX concentration decreased to 0.606gml. The serum creatinine level decreased to within the normal range on the sixth day of admission. We concluded that transient renal dysfunction could have been caused by an overdose of TFLX because 1the patient recovered rapidly after TFLX was discontinued, 2the serum TFLX concentration was extremely high, and 3filling defects observed in the renal medulla were indicative of tubulointerstitial damage, which is a known side effect of new quinolone antibiotics. In Japan, TFLX is the first fluoroquinolone antibiotic prescribed for pneumonia and otitis media in children, at a recommended dose of 12 mgkg day. Reports suggest that the blood concentration of TFLX tends to increase with increasing body weight up to 30 kg in childrentherefore, it should be prescribed at an appropriate dose

表 1 WBC 7,700/μ C3 142 mg/d 1.014 Eos 2.3 C4 41 mg/d ph 7.0 Hb 12 g/d IgG 984 mg/d 2+ TP 6.9 g/d IgA 323 mg/d 3+ Alb 3.7 g/d IgM 110 mg/d 1+ BUN 19.2

表 1 WBC 7,700/μ C3 142 mg/d 1.014 Eos 2.3 C4 41 mg/d ph 7.0 Hb 12 g/d IgG 984 mg/d 2+ TP 6.9 g/d IgA 323 mg/d 3+ Alb 3.7 g/d IgM 110 mg/d 1+ BUN 19.2 症 例 報 告 1 1 1 2 1 1 1 3 24 11 5 25 3 14 要 14 5 Cr 1.7 mg/d egfr 45.0 m /min/1.73 m 2 β2mg 45,400 μg/ IgA 序 Mycoplasma pneumoniae 症 旨 言 例 症 例 :14 主 訴 : 1 815-8555 3-1-1 2 3 家 族 歴 : 既 往 歴 :3 2 生 活 歴 : 現

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