日本化学療法学会雑誌第50巻第6号
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- ああす かむら
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1 Streptococcus pneumoniae Haemophilus influenzae amoxicillin AMPC cefditoren pivoxil CDTR AMPC 50 mg kg day CDTR 9mg kg day CDTR 18 mg kg day S. pneumoniae H. influenzae S. pneumoniae 18 H. influenzae 4 S. pneumoniae H. influenzae 3 S. pneumoniae 18 S. pneumoniae 2 S. pneumoniae PSSP 2 PISP 4 PRSP 17 H. influenzae lactamase BLNAS 3 lactamase BLNAR 4 2 PSSP PISP AMPC PSSP AMPC PRSP PRSP 17 AMPC 2 4 PRSP 11 3 CDTR 1 AMPC 1 16 CDTR PRSP 1 PRSP 1 PRSP PRSP S. pneumoniae BLNAS 3 AMPC CDTR CDTR 1 BLNAS 1 BLNAS BLNAR 4 AMPC CDTR 2 BLNAR BLNAR H. influenzae 4 S. pneumoniae H. influenzae AMPC Key words: Streptococcus pneumoniae Haemophilus influenzae acute otitis media nasopharyngeal flora antibiotics Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis S. pneumoniae H. influenzae carrier forcus S. pneumoniae H. influenzae
2 S. pneumoniae H. influenzae amoxicillin AMPC cefditoren pivoxil CDTR I 1 S. pneumoniae H. influenzae 25 carrier forcus S. pneumoniae H. influenzae AMPC 50 mg kg day 3 14 CDTR 9mg kg day 3 14 CDTR 18 mg kg day First bacteriological examination first day antibiotics execution AMPC 50 mg/kg/day Second third day examination forth day antibiotics execution disappear AMPC 50 mg/kg/day remain CDTR 9 mg/kg/day Third seventh day examination eighth day antibiotics execution AMPC 50 mg/kg/day execution disappear CDTR 9 mg/kg/day execution remain CDTR 18 mg/kg/day Forth eleventh day examination twelfth day antibiotics not execution AMPC 50 mg/kg/day execution CDTR 9 mg/kg/day execution CDTR 18 mg/kg/day Fifth fourteenth day examination execution execution execution AMPC: amoxicillin, CDTR: cefditoren-pivoxil Fig. 1 Schedule of bacteriological examination and antibiotic treatment.
3 Fig. 1 2 PCR PCR S. pneumoniae H. influenzae S. pneumoniae H. influenzae polymerase chain reaction PCR 2 Ubukata S. pneumoniae lyta PBP pbp 1 a pbp 2 b pbp 2 x rrna ermam efflux mefe H. influenzae H. influenzae P6 PBP pbp 3 17 II Table 1 25 S. pneumoniae 18 H. influenzae 4 S. pneumoniae H. influenzae 3 S. pneumoniae 18 2 S. pneumoniae S. pneumoniae PSSP 2 2 PISP 4 4 PRSP H. influenzae lactamase BLNAS 3 3 lactamase BLNAR S. pneumoniae H. influenzae Table 1 PSSP 2 AMPC PRSP PRSP CDTR CDTR PSSP PISP 4 3 AMPC PISP 4 PSSP PISP PRSP BLNAS BLNAR PRSP 17 AMPC 2 4 PRSP PRSP PSSP PRSP CDTR 1 AMPC 1 16 CDTR 1 PRSP PRSP AMPC 1 PRSP CDTR PRSP PRSP S. pneumoniae 23 9 S. pneumoniae PRSP BLNAS 3 AMPC CDTR CDTR AMPC CDTR CDTR 1 1 BLNAR 4 AMPC CDTR 2 AMPC CDTR BLNAR H. influenzae Table 1 S. pneumoniae 13 S. pneumoniae 5 1 PSSP PRSP 4 PRSP PRSP
4 Table 1 1 Patient s profil and carriage of Streptococcus pneumoniae and Haemophilus influenzae before and after treatment by amoxicillin and cefditoren pivoxil Case Age Gender Day care Clinical result First M antibiotics germ variation germ volume 1 13 boy good AMPC pbp 1a2b2x,ermAM PRSP 2 BLNAS boy good AMPC pbp 2 x PISP M 1 BLNAS boy good AMPC pbp 3 BLNAR boy poor AMPC pbp 1a2b2x,mefE PRSP boy good AMPC pbp 2 x PISP M boy good AMPC pbp 1a2b2x PRSP boy good AMPC pbp 1a2b2x,ermAM PRSP boy good AMPC pbp 1a2b2x,mefE PRSP girl good AMPC pbp 3 BLNAR girl poor AMPC pbp 1a2b2x,mefE PRSP 2 pbp 2 x, ermam PISP M girl poor AMPC pbp 1a2b2x PRSP girl good AMPC pbp 3 BLNAR girl poor AMPC pbp 1a2b2x,mefE PRSP girl poor AMPC mefe PRSP 2 BLNAS girl good AMPC pbp 1a2b2x PRSP girl good AMPC pbp 1a2b2x,mefE PRSP girl poor AMPC PSSP girl good AMPC pbp 2 x PISP 3 pbp 1a2b2x,mefE PRSP girl good AMPC pbp 1a2b2x,mefE PRSP girl good AMPC pbp 1a2b2x PRSP girl poor AMPC pbp 1a2b2x,mefE PRSP girl good AMPC pbp 3 BLNAR girl good AMPC pbp 1a2b2x,mefE PRSP girl good AMPC pbp 1a2b2x,ermAM PRSP girl poor AMPC pbp 1a2b2x PRSP 3 In clinical result good: recovery case from acute otitis media at the last examination, poor: otitis prone case at the last examination In antibiotics AMPC: amoxicillin In germ PSSP: penicillin susceptible S. pneumoniae, PISP: penicillin intermediate resistant S. pneumoniae, PRSP: penicillin resistant S. pneumoniae, BLNAS: β lactamase negative ampicillin susceptible H. influenzae, BLNAR: β lactamase netative ampicillin resistant H. influenzae
5 Table 1 2 Patient s profil and carriage of Streptococcus pneumoniae and Haemophilus influenzae before and after treatment by amoxicillin and cefditoren pivoxil Case Second Third antibiotics germ variation germ volume antibiotics germ variation germ volume 1 CDTR disappear CDTR disappear BLNAS 1 disappear 2 AMPC disappear AMPC none disappear none 3 AMPC AMPC disappear none 4 CDTR pbp 1a2b2x,mefE PRSP 2 CDTR pbp 1a2b2x,mefE PRSP 2 5 AMPC disappear AMPC none 6 CDTR pbp 1a2b2x,mefE PRSP 2 CDTR pbp 1a2b2x,mefE PRSP 3 7 CDTR pbp 1a2b2x,ermAM PRSP 2 CDTR pbp 1a2b2x,ermAM PRSP 2 8 CDTR pbp 1a2b2x,mefE PRSP 2 CDTR pbp 1a2b2x,mefE PRSP 2 9 CDTR CDTR pbp 3 BLNAR 1 disappear 10 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR pbp 1a2b2x,mefE PRSP 3 disappear none pbp 3, TEM BLNAR 3 disappear 11 CDTR pbp 1a2b2x PRSP 2 CDTR pbp 1a2b2x PRSP 2 BLNAS 1 12 CDTR CDTR pbp 3 BLNAR 1 disappear 13 CDTR pbp 1a2b2x PRSP 2 CDTR pbp 1a2b2x PRSP 2 pbp 3 BLNAR 1 pbp 3 BLNAR 1 14 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR pbp 1a2b2x,mefE PRSP 2 BLNAS 2 BLNAS 1 15 CDTR pbp 1a2b2x PRSP 1 CDTR pbp 1a2b2x PRSP 2 pbp 1a2b2x,mefE PRSP 2 disappear pbp 3 BLNAR 1 16 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR pbp 1a2b2x,mefE PRSP 2 17 CDTR pbp 1a2b2x PRSP 3 CDTR pbp 1a2b2x PRSP 2 18 CDTR disappear CDTR none pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 19 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR disappear 20 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR pbp 1a2b2x,mefE PRSP 3 pbp 3 BLNAR 3 21 CDTR pbp 1a2b2x,mefE,ermAM PRSP 3 CDTR pbp 1a2b2x,mefE,ermAM PRSP 22 AMPC AMPC disappear none 23 CDTR pbp 1a2b2x,mefE PRSP 3 CDTR pbp 1a2b2x,mefE PRSP 2 BLNAS 1 disappear 24 CDTR pbp 1a2b2x,ermAM PRSP 3 CDTR pbp 1a2b2x,ermAM PRSP 3 pbp 3 BLNAR 1 disappear 25 AMPC disappear AMPC none In antibiotics AMPC: amoxicillin, CDTR :cefditoren pivoxil 9 mg kg day CDTR :cefditoren pivoxil 18 mg kg day In germ PISP: penicillin intermediate resistant S. pneumoniae, PRSP: penicillin resistant S. pneumoniae, BLNAS: β lactamase negative ampicillin susceptible H. influenzae,blnar: β lactamase netative ampicillin resistant H. influenzae,none: not execution
6 Table 1 3 Patient s profil and carriage of Streptococcus pneumoniae and Haemophilus influenzae before and after treatment by amoxicillin and cefditoren pivoxil Case Forth Fifth Bacteriological antibiotics germ variation germ volume germ variation germ volume result 1 CDTR 2 AMPC 3 AMPC 4 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 remnant 5 AMPC 6 CDTR pbp 1a2b2x,mefE PRSP 3 pbp 1a2b2x,mefE PRSP 3 change 7 CDTR pbp 1a2b2x,ermAM PRSP 2 pbp 1a2b2x,ermAM PRSP 2 remnant 8 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 remnant 9 CDTR 10 CDTR pbp 1a2b2x,mefE PRSP 3 pbp 1a2b2x PRSP 3 change 11 CDTR pbp 1a2b2x PRSP 2 pbp 1a2b2x PRSP 2 remnant disappear disappear disappearance 12 CDTR 13 CDTR pbp 1a2b2x PRSP 2 pbp 1a2b2x PRSP 2 change disappear disappear disappearance 14 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 change disappear disappear disappearance 15 CDTR pbp 1a2b2x PRSP 2 pbp 1a2b2x PRSP 2 remnant disappear disappear disappearance 16 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 3 remnant 17 CDTR pbp 1a2b2x PRSP 3 pbp 1a2b2x PRSP 3 change 18 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 remnant 19 CDTR 20 CDTR pbp 1a2b2x,mefE PRSP 3 pbp 1a2b2x,mefE PRSP 3 change pbp 3 BLNAR 1 pbp 3 BLNAR 1 appearance 21 CDTR pbp 1a2b2x,mefE,ermAM PRSP 3 pbp 1a2b2x,mefE,ermAM PRSP 3 change 22 AMPC 23 CDTR pbp 1a2b2x,mefE PRSP 2 pbp 1a2b2x,mefE PRSP 2 remnant none BLNAS 1 appearance 24 CDTR pbp 1a2b2x,ermAM PRSP 3 pbp 1a2b2x,ermAM PRSP 3 remnant 25 AMPC none pbp 1a2b2x,mefE PRSP 3 change In antibiotics AMPC: amoxicillin, CDTR :cefditoren pivoxil 9 mg kg day CDTR :cefditoren pivoxil 18 mg kg day In germ PRSP: penicillin resistant S. pneumoniae, BLNAS: β lactamase negative ampicillin susceptible H. influenzae, BLNAR: β lactamase netative ampicillin resistant H. influenzae,none: not execution
7 8 H. influenzae 4 AMPC CDTR 1 BLNAR BLNAR CDTR S. pneumoniae H. influenzae 8 S. pneumoniae 7 S. pneumoniae 2 H. influenzae 2 PRSP S. pneumoniae 1 8 S. pneumoniae H. influenzae S. pneumoniae 2 S. pneumoniae PSSP AMPC PRSP S. pneumoniae H. influenzae BLNAS 1 BLNAR 2 3 Table 1 III S. pneumoniae S. pneumoniae 1967 Hansman 18 S. pneumoniae PRSP S. pneumoniae PRSP 3 9 H. influenzae lactamase lactamase H. influenzae BLNAR 2 17 S. pneumoniae PRSP PISP 3 9 H. influenzae 3 carrier forcus S. pneumoniae H. influenzae carrier forcus S. pneumoniae H. influenzae 1 AMPC CDTR CDTR S. pneumoniae S. pneumoniae PSSP PISP AMPC PSSP 2 PRSP PRSP PRSP S. pneumoniae PSSP PRSP PRSP PRSP
8 11 CDTR PSSP 2 4 PISP PRSP PRSP 2 PISP 1 Ghaffar 12 amoxicillin clavulanate CVA AMPC azithromycin AZM CVA AMPC PSSP PISP 75 PRSP 40 AZM AZM 2 3 Cohen CVA AMPC cefpodoxime proxetil CPDX 13 2 CVA AMPC ceftriaxone CTRX 14 CVA AMPC CPDX 13 CPDX 107 S. pneumoniae PSSP 58 PISP 27 PRSP 12 PSSP 15 PISP 27 PRSP 15 CVA AMPC 185 S. pneumoniae PSSP 59 PISP 25 PRSP 20 PSSP 9 PISP 15 PRSP PSSP PISP PRSP CTRX CVA AMPC 14 CTRX 247 S. pneumoniae PSSP 65 PISP 37 PRSP 4 PSSP 36 PISP 23 PRSP 40 CVA AMPC 250 S. pneumoniae PSSP 71 PISP 32 PRSP 48 PSSP 7 PISP 12 PRSP 22 CTRX 99 CVA AMPC 41 CTRX PSSP PISP PRSP CVA AMPC 41 7 PSSP PISP PRSP PSSP PISP PRSP S. pneumoniae PSSP PSSP PSSP PISP AMPC CDTR PISP H. influenzae 7 BLNAS AMPC CDTR CDTR 1 BLNAR AMPC CDTR 2 BLNAS BLNAR 1 11 CDTR CDTR Ghaffar 12 CVA AMPC AZM CVA AMPC lactamase H. influenzae 7 2 lactamase H. influenzae 10 8 AZM lactamase H. influenzae 9 2 lactamase H. influenzae 13 4 Cohen CVA AMPC CPDX 13 CVA AMPC CTRX 14 CVA AMPC CPDX 13 CVA AMPC lactamase H. influenzae 32 4 lactamase H. influenzae 43 4 CPDX lactamase
9 H. influenzae 26 4 lactamase H. influenzae 46 9 CVA AMPC CTRX 14 CVA AMPC lactamase H. influenzae 38 4 lactamase H. influenzae CTRX lactamase H. influenzae lactamase H. influenzae lactamase H. influenzae Ghaffar 12 Cohen lactamase BLNAS BLNAR lactamase H. influenzae BLNAR 2 PISP PRSP PSSP PISP 1 PRSP 11 PRSP PRSP S. pneumoniae 1 PSSP PRSP 4 PRSP PRSP PRSP PRSP H. influenzae 4 4 BLNAR AMPC CDTR CDTR 1 BLNAR CDTR 3 S. pneumoniae S. pneumoniae S. pneumoniae S. pneumoniae Ghaffar 12 CVA AMPC PRSP AZM PRSP CVA AMPC AZM S. pneumoniae PRSP S. pneumoniae S. pneumoniae S. pneumoniae Ghaffar 12 S. pneumoniae S. pneumoniae S. pneumoniae S. pneumoniae S. pneumoniae AMPC CDTR CDTR S. pneumoniae H. influenzae
10 1 : Haemophilus influenzae, Streptococcus pnemoniae Moraxella catarrhalis Jap J Antibiotics 50: : 16 S 2 : : 16: : 19: : 1 8: : 12: : JOHNS 13: : 101: : 47: : 82: : 49 S A : Ghaffar F, Stella L, Katz K, et al.: Effects of Amoxicillin Clavulanate or Azithromycin on nasopharyngeal Carriage of Streptococcus pneumoniae and Haemophilus influenzae in Children with Otitis Media. Clin Infect Dis 31: Cohen R Bingen E Varon E et al.: Change in nasopharyngeal carriage of Streptococcus pneumoniae resulting from antibiotic therapy for acute otitis media in children. Pediatr Infect Dis J 16: Cohen R, Navel M, Grunberg J, et al.: One dose ceftriaxone vs. ten days of amoxicillin clavulanate therapy for acute otitis media: clinical efficancy and change in nasopharyngeal flora. Pediatr Infect Dis J 18: Ubukata K, Muraki T, Igarashi A, et al.: Identification of penicillin and Other Beta Lactam Resistance in Streptococcus pneumoniae using Polymerase Chain Reaction. J Infect Chemother 3: Ubukata K, Iwata S, Sunakawa K, et al.: In Vitro Activities of New Ketolide HMR 3647 and Other Macrolide Antibiotics Against Streptococcus pneumoniae Having ermam and Genes that Mediate macrolide. Antimicrob Agents Chemother in press 17 : BLNAR 9: Hansman D, Bullen M M: A resistant pneumococcus. Lancet 2: Jacobs M R Koornhof H J Robins Browne R M et al.: Emergence of multiply resistant pneumococci. NEngl J Med 299: : Jap J Antibiotics 34: : 92:
11 Changes in nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae from amoxicillin and cefditoren pivoxil therapy in children with acute otitis media Yoshihumi Uno UNO ENT Clinic Tomihara Okayama Japan Acute otitis media is one of the most common upper respiratory infection diseases in childhood. The most common organisms causing it are Streptococcus pneumoniae and Haemophilus influenzae In children the nasopharynx is the carrier focus for upper respiratory infection diseases such as acute otitis media, and S. pneumoniae and H. influenzae colonize the nasopharynx. We studied the changes in nasopharyngeal carriage of S. pneumoniae and H. influenzae before and after amoxicillin AMPC and cefditoren pivoxil CDTR therapy using a polymerase chain reaction to detect penicillin binding protein genes and macroride resistant genes with the following results: 1. In 25 cases 18 showed S. pneumoniae only 4 H. influenzae only and 3 detected cases. In the 18 having only S. pneumoniae 2 consisted of a different type of S. pneumoniae In 23 strains of S. pneumoniae 2 were penicillin susceptible S. pneumoniae PSSP 4 penicillin intermediate resistant S. pneumoniae PISP and 17 penicillin resistant S. pneumoniae PRSP In the 7 strains of H. influenzae 3 were lactamase negative ampicillin susceptible H. influenzae BLNAS and 4 lactamase negative ampicillin resistant H. influenzae BLNAR 2. All PSSP and PISP were removed from the nasopharynx with AMPC but in PSSP PRSP was detected in all cases after AMPC therapy. In the 17 strains of PRSP recognized initially 2 wereremoved from the nasopharynx with AMPC therapy 4changed to other strain types with AMPC therapy and of the 11 strains remaining 3 new strains appeared. With CDTR 9mg kg day therapy 2 strains were removed and 16 remained. With CDTR 18 mg kg day therapy 1 strainchanged to another type and 1newstrainappeared. Ultimately 17 strains remained but only 9 existed from the beginning. 3. All 3 BLNAS strains were removed from the nasopharynx with AMPC CDTR 9mg kg day and CDTR 18 mg kg day therapy. During these therapies however 3 BLNASappeared and only 1 strain ultimately remained in the nasopharynx. All 4 BLNAR strains were removed from the nasopharynx with AMPC with 3 new strains appearing and CDTR 18 mg kg day with 2 new strains appearing. One strain ultimately remained in the nasopharynx. All strains recognized initially were removed. 4. No relationship was seen between S. pneumoniae and H. influenzae remaining in the nasopharynx and results of acute otitis media therapy. But it was recognized the tendencies that in the good result cases the rate of the removal of the bacteria from the beginning were high and allofthem removed with AMPC and in the poor result cases the removal of the bacteria fromthebeginning were not high and bacteria from the beginning changed to the different bacteria which had different pattern of the resistant genes.
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