Key words: HAPA-B, AMK, Comparative study, Respiratory tract infections

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2 Key words: HAPA-B, AMK, Comparative study, Respiratory tract infections

3 Fig. 1 Chemical structure of HAPA-B

4 Table 1 Collaborating clinics The First Department of Internal Medicine, Kyorin University, School of Medicine The Second Department of Internal Medicine, School of Medicine, Hokkaido University The First Department of Internal Medicine, Asahikawa Medical College Department of Internal Medicine, Iwamizawa Rohsai Hospital The 3rd Internal Medicine, Hirosaki University, School of Medicine The Third Department of Internal Medicine, School of Medicine, Iwate Medical University Respiratory Division, Iwaki Kyoritsu General Hospital Department of Internal Medicine, Kasumigaura National Hospital The Second Department of Internal Medicine, The Jikei University School of Medicine Department of Chest Medicine, National Medical Center Hospital The First Department of Internal Medicine, School of Medicine, Showa University Department of Internal Medicine, Kawasaki Municipal Hospital Department of Internal Medicine, Kawasaki Chuo Hospital First Department of Internal Medicine, Yokohama City University, School of Medicine Department of the Chest, Kanagawa Prefectural Nagahama Hospital Department of Internal Medicine, Shinrakuen Hospital Department of Internal Medicine, Toyama Prefectural Central Hospital The First Department of Internal Medicine, Toyama Medical and Pharmaceutical University The First Department of Internal Medicine, Nagoya University, School of Medicine The First Department of Internal Medicine, Nagoya City University, School of Medicine Respiratory Division, Nagahama Red Cross Hospital Division of Respiratory Medicine, Shiga Medical Center for Adult Disease Department of Internal Medicine, Moriyama City Hospital Department of Internal Medicine, Public Koga Hospital Department of Respiratory Disease, Kyoto City Hospital Respiratory Division, Kyoto Katsura Hospital Department of Internal Medicine, Saiseikai Ibaraki Hospital Department of Internal Medicine, Tane General Hospital The Fourth Department of Internal Medicine, Kinki University, School of Medicine Division of Respiratory Diseases Department of Medicine, Kawasaki Medical School The Second Department of Internal Medicine, Hiroshima University, School of Medicine The First Department of Internal Medicine, Faculty of Medicine, and School of Health Sciences, Kyushu University Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University Clinical Research Division, The National Minami Fukuoka Chest Hospital The Second Department of Internal Medicine, Medical College of Oita The Second Department of Internal Medicine, Nagasaki University School of Medicine Department of Internal Medicine, Institute for Tropical Medicine, Nagasaki University The First Department of Internal Medicine, Kumamoto University, School of Medicine Department of Internal Medicine, Kumamoto Municipal Hospital Department of Internal Medicine, National Kirishima Hospital

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7 Table 2 Criteria for judgement of usefulness by committee members

8 Table 3 Criteria for evaluation of clinical symptoms

9 Table 4 Case distribution Table 5 Reasons for exclusion from evaluation of clinical effectiveness

10 Table 6 Diagnosis judged by committee members Table 7 Background of patients-characteristics of patients (1)-

11 Table 8 Background of patients-characteristics of patients (2)- a) Malignant tumor, congestive heart failure, central nervous disturbance, diabetes mellitus, chronic respiratory disease b) Diseases other than A group Table 9 Background of patients-initial symptoms (1)-

12 Table 9 (continued) Table 10 Background of patients-initial symptoms (2)-

13 Table 11 Background of patients-initial chest X-ray findings (Pneumonia)- Table 12 Background of patients-causative bacteria-

14 Table 13 Background of patients-susceptibility of causative bacteria- Table 14 Duration of medication Fig. 2 Clinical effectiveness judged by committee members

15 Table 15 Clinical effectiveness judged by committee members Table 16 Clinical effectiveness judged by committee members classified by initial severity

16 Table 17 Clinical effectiveness judged by committee members classified by causative bacteria

17 Table 18 Clinical effectiveness judged by committee members classified by age-all Table 19 Clinical effectiveness judged by committee members classified by age-chronic cases- RTI-

18 Table 20 Clinical effectiveness judged by committee members classified by ESR-Pneumonia- Table 21 Bacteriological response classified by causative bacteria-all cases-

19 Table 21 (continued)

20 Table 22 Bacteriological response classified by causative bacteria-pneumonia-

21 Table 23 Bacteriological response classified by causative bacteria-chronic RTI-

22 Table 24 Causative bacteria and isolated bacteria after treatment Fig. 3 Profile of symptomatic improvement All cases

23 Fig. 4 Profile of symptomatic improvement Pneumonia Table 25 Improvement of chest X-ray findings -Pneumonia-

24 Fig. 5 Profile of symptomatic improvement Chronic RTI Table 26 Clinical effectiveness judged by bedside doctors in charge

25 Fig. 6 Clinical effectiveness judged by bedside doctors in charge Table 27 Side effects judged by committee members

26 Table 28 Abnormal changes in laboratory findings judged by committee members Table 29 Usefulness judged by committee members

27 Table 30 Usefulness judged by bedside doctors in charge

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29 2) Morohoshi, T., Toriya, M., Yokoiyama, S., Fujimoto, K., Hayano, K., Goto, S. & Tsuji, A.: The acetylation of 6'-amino group of amikacin by a new enzyme prepared from Serratia sp. J. Antibiotics, 37: , 1984.

30 Comparison of HAPA-B and Amikacin in the Treatment of Respiratory Tract Infections Hiroyuki KOBAYASHI, Hiroshi OSHITANI & Masahiko YOSHIDA The First Department of Internal Medicine, Kyorin University, School of Medicine Akira SAITO & Ichiro NAKAYAMA The Second Department of Internal Medicine, School of Medicine, Hokkaido University Sokichi ONODERA & Nobuhiro SASAKI The First Department of Internal Medicine, Asahikawa Medical College Fumio NAGAHAMA*, Yomei HIRAGA, Takehito NAKABAYASHI, Kyuichiro SEKINE & Jutaro SHIMOMURA Department of Internal Medicine, Iwamizawa Rohsai Hospital and Related Hospitals (* Present address: Sapporo National Hospital) Kazuo TAKEBE, Shiro KOSAKA, Mitsuo MASUDA, Seiichi MURAKAMI, Kenichi KIMURA, Hideaki KASHIWAMURA & Keiko GASA The 3rd Internal Medicine, Hirosaki University, School of Medicine and Related Hospitals Masao TAMURA, Kazuki KONISHI, Takashi ITO, Yoshikatsu NEMOTO, Hiroshi KURAMITSU & Kazutoshi GOMI The Third Department of Internal Medicine, School of Medicine, Iwate Medical University and Related Hospitals Izumi HAYASHI Respiratory Division, Iwaki Kyoritsu General Hospital Masataka KATSU, Hajime YAMAGATA & Minoru SATOH Department of Internal Medicine, Kasumigaura National Hospital Yasushi UEDA The Jikei University School of Medicine Atsushi SAITO & Tadashi MIYAHARA The Second Department of Internal Medicine, The Jikei University School of Medicine Junzaburo KABE, Koichiro KUDOH, Yasuyuki SANO & Michiko HAIDA Department of Chest Medicine, National Medical Center Hospital Terumi TAKAHASHI & Keita KASAHARA The First Department of Internal Medicine, School of Medicine, Showa University Ippei FUJIMORI, Yoshio KOBAYASHI & Seiji MITA Department of Internal Medicine, Kawasaki Municipal Hospital Takeshi MITSUI Department of Internal Medicine, Kawasaki Chuo Hospital Takao OKUBO & Akira ITO First Department of Internal Medicine, Yokohama City University, School of Medicine Shigeki ODAGIRI, Kaneo SUZUKI & Koou MUROHASHI Department of the Chest, Kanagawa Prefectural Nagahama Hospital Osamu SEKINE, Yoshimaru USUDA & Nobuki AOKI Department of Internal. Medicine, Shinrakuen Hospital

31 Kaoru OYAMA Department of Internal Medicine, Toyama Prefectural Central Hospital Naohiro YAMASHITA & Saburo YANO The First Department of Internal Medicine, Toyama Medical and Pharmaceutical University Kaoru SHIMOKATA, Yoshihiro SENDA, Yoshio TORII, Saizi YOSHII, Keisuke NISHIWAKI & Osamu KOHNOU The First Department of Internal Medicine, Nagoya University, School of Medicine and Related Hospitals Masahito KATO, Joichi KATO, Hidekazu HANAKI & Toshihiko TAKEUCHI The First Department of Internal Medicine, Nagoya City University, School of Medicine and Related Hospitals Kikuo SUGIMOTO Respiratory Division, Nagahama Red Cross Hospital Kazue SHIMADA & Takafumi FUKUNAGA Division of Respiratory Medicine, Shiga Medical Center for Adult Disease Kisao SATAKE Department of Internal Medicine, Moriyama City Hospital Hikaru OHTA & Toshio NISHIMURA Department of Internal Medicine, Public Koga Hospital Michiro NAKASHIMA Department of Respiratory Disease, Kyoto City Hospital Sadao IKEDA Respiratory Division, Kyoto Katsura Hospital Hidehiro NANBA Department of Internal Medicine, Saiseikai Ibaraki Hospital Fumio MIKI, Yoshiyasu IKUNO, Eiji INOUE, Minoru YOSHIYAMA, Tooru HIRAGA & Akihito MURATA Department of Internal Medicine, Tane General Hospital Shigenori NAKAJIMA, Yasuo TSUYA & Hiroki UENISHI The Fourth Department of Internal Medicine, Kinki University, School of Medicine Rinzo SOEJIMA, Hiroshi KAWANE, Yoshihito NIKI, Susumu YAGI & Masaru SUMI Division of Respiratory Diseases Department of Medicine, Kawasaki Medical School Michiro YAMAKIDO, Akimitsu KAMITSUNA, Masakazu ITASAKA & Kenji HASEGAWA The Second Department of Internal Medicine, Hiroshima University, School of Medicine Yoshiro SAWAE, Kaoru OKADA & Yukio KUMAGAI The First Department of Internal Medicine, Faculty of Medicine, and School of Health Sciences, Kyushu University Shinichiro HAYASHI & Nobuaki SHIGEMATSU Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University Hitoshi NAGANO, Chiharu KUBO & Masahito KARIYA Clinical Research Division, The National Minami Fukuoka Chest Hospital Masaru NASU, Jun GOTO & Yoichiro GOTO The Second Department of Internal Medicine, Medical College of Oita Kohei HARA, Atsushi SAITO, Keizo YAMAGUCHI, Yoshiteru SHIGENO, Shigeru KOHNO, Toshiyuki OE, Kiyo FUJITA, Yasuko UEDA & Kota KOHNO The Second Department of Internal Medicine, Nagasaki University School of Medicine and Related Hospitals Keizo MATSUMOTO, Toshiaki YOSHIDA & Kazunori OISHI Department of Internal Medicine, Institute for Tropical Medicine, Nagasaki University Shukuro ARAKI, Masayuki ANDO & Moritaka SUGA The First Department of Internal Medicine, Kumamoto University, School of Medicine

32 Kiyoshi SHIMA, Yasutsugu FUKUDA, Katsumasa TOKUNAGA, Shinobu TAKENAKA, Sadanobu HIGUCHI, Ryuji FUJISE, Jiro TAMIYA, Yuichi MOTOZATO, Kiyotaka ITO & Kiyonori ITSUNO Department of Internal Medicine, Kumamoto Municipal Hospital and Related Hospitals Takehiko SAKURAMI & Kunio FUJISAKI Department of Internal Medicine, National Kirishima Hospital The clinical effectiveness, safety and usefulness of HAPA-B, a new aminoglycoside, in the treatment of respiratory tract infections were compared with those of amikacin (AMK) ina double blind study. The following diseases were included in this study; bacterial pneumonia, pulmonary suppression, infectious exacerbation of chronic bronchitis and diffuse panbronchiolitis and chronic respiratory tract diseases with infection (bronchiectasis, pulmonary emphysema, lung fibrosis, bronchial asthma). HAPA-B and AMK were intramusculary administered twice a day for 14 days, at a daily dose of 400 mg of both drugs (one ampoule containing 200 mg). The following results were obtained. 1) Case distribution Total cases administered HAPA-B or AMK were 218 patients. Out of these cases, 185 patients (HAPA-B 98, AMK 87) were evaluated on clinical effectiveness, 207 (HAPA-B 108, AMK 99) on side effects, 193 (HAPA-B 102, AMK 91) on laboratory findings, 182 (HAPA-B 96, AMK 86) on usefulness. 2) Clinical effectiveness Out of 98 patients in HAPA-B group, one patient was judged as "Excellent", 65 as "Good", 9 as "Fair", 23 as "Poor" and the efficacy rate was 67.3%. On the other hand, out of 87patients in AMK group, one patient was judged as "Excellent", 56 as "Good", 10 as "Fair", 20 as "Poor" and the efficacy rate was 65.5%. There was no significant difference between two groups. However, the improvement rates of HAPA-B group in cough, dyspnea and volume of sputum were significantly superior to those of AMK at 3rd or 7th day after administration. 3) Bacteriological effect Bacteriologically, the eradication rate of 60.6% was observed out of 66 clinical isolates in HAPA-B group and it was 59.5% in 42 clinical isolates in AMK group. There was no significant difference between two groups. 4) Side effects and abnormal changes in laboratory findings Side effects were observed in 3 of 108 patients (2.8%) with HAPA-B and 6 of 99 patients (6.1%) with AMK. Allergic symptoms were observed in both groups but pain at the injection site and dizziness were observed only in AMK group. Abnormal changes in laboratory findings were observed in 20 of 102 patients (19.6%) with HAPA-B and 27 of 91 patients (29.7%) with AMK after administration. Elevations of BUN and s-creatinine were observed only in AMK group, while eosinophilia and elevation of transaminases were observed in both groups. There was no significant difference between two groups. 5) Usefulness The usefulness of HAPA-B group was 65.6% and that of AMK was 62.8% judged by committee members. The usefulness judged by doctors in charge of HAPA-B group was 65.2% and that of AMK was 54.8%. There was no significant difference between two groups. 6) From the above results, it was concluded that clinical effectiveness of HAPA-B was at least equal to that of AMK in the treatment of respiratory tract infections and because of no adverse reaction to renal and auditory functions, HAPA-B was considered to be a useful aminoglycoside.

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