Educational effects using a robot patient simulation system for development of clinical attitude

INTRODUCTION

The aim of this study was to assess the effectiveness of improving the attitude of dental students towards the use of a full-body patient simulation system (SIMROID) compared to the traditional mannequin (CLINSIM) for dental clinical education.

MATERIALS AND METHODS

The participants were 10 male undergraduate dental students who had finished clinical training in the university hospital 1 year before this study started. They performed a crown preparation on an upper pre-molar tooth using SIMROID and CLINSIM as the practical clinical trials. The elapsed time for preparation was recorded. The taper of the abutment teeth was measured using a 3-dimensional shape-measuring device after this trial. In addition, a self-reported questionnaire was collected that included physical pain, treatment safety and maintaining a clean area for each simulator. Qualitative data analysis of a free format report about SIMROID was performed using text mining analysis. This trial was performed twice at 1-month intervals.

RESULTS

The students considered physical pain, treatment safety and a clean area for SIMROID significantly better than that for CLINSIM (P < .01). The elapsed time of preparation in the second practical clinical trial was significantly lower than in the first for SIMROID and CLINSIM (P < .01). However, there were no significant differences between the abutment tapers for both systems. For the text mining analysis, most of the students wrote that SIMROID was similar to real patients.

CONCLUSION

The use of SIMROID was proven to be effective in improving the attitude of students towards patients, thereby giving importance to considerations for actual patients during dental treatment.

Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic activity

Sleep bruxism (SB) subjects show a higher incidence of rhythmic masticatory muscle activity (RMMA) than control subjects. RMMA is associated with sleep micro-arousals. This study aims to: (i) assess RMMA/SB episodes in relation to sleep cycles; (ii) establish if RMMA/SB and micro-arousals occur in relation to the slow wave activity (SWA) dynamics; (iii) analyze the association between RMMA/SB and autonomic cardiac activity across sleep cycles. Two nights of polygraphic recordings were made in three study groups (20 subjects each): moderate to high SB, low SB and control. RMMA episodes were considered to occur in clusters when several groups of RMMA or non-specific oromotor episodes were separated by less than 100 s. Correlations between sleep, RMMA/SB index and heart rate variability variables were assessed for the first four sleep cycles of each study group. Statistical analyses were done with SYSTAT and SPSS. It was observed that 75.8% of all RMMA/SB episodes occurred in clusters. Micro-arousal and SB indexes were highest during sleep cycles 2 and 3 (P < 0.001). Within each cycle, micro-arousal and RMMA/SB indexes showed an increase before each REM sleep (P <or= 0.02). The cross-correlation plot for micro-arousal index showed positive association from 4 min preceding SB onset in the moderate to high SB subjects (P <or= 0.06). The cross-correlation plot revealed that SWA decreases following SB onset (P <or= 0.05). Further cross-correlation analysis revealed that a shift in sympatho-vagal balance towards increased sympathetic activity started 8 min preceding SB onset (P <or= 0.03). In moderate to severe SB subjects, a clear increase in sympathetic activity precedes SB onset.

[Spinal cord protection and operative results of the thoracoabdominal aortic aneurysm]

The purpose of this study was to review retrospectively recent results in 75 patients undergoing thoracoabdominal aortic operations using the technique of distal aortic perfusion with segmental aortic clamping. Between July 1997 and November 2003, 46 males (61%) and 29 females (39%) were treated. The patients ranged in age from 26 to 82 (mean 63 +/- 13) years. Indications for surgery included dissecting thoracoabdominal aortic aneurysm (n = 28), atherosclerotic thoracoabdominal aortic aneurysm (n = 46), and traumatic aneurysm (n = 1). Emergency operation was performed in 8 (11%). The extent of aneurysm was Crawford type I in 12 patients, type II in 19, type III in 34, and type IV in 10. Profound hypothermic circulatory arrest was used in 3 patients and retrograde segmental clamping technique in 5. Cerebrospinal fluid drainage and naloxone hydrochloride administration were performed as adjunctive methods since February 2000. There were 6 (8%) in-hospital deaths. The overall incidence of postoperative paraplegia or paraparesis was 8% (6/75). Although the survival rate has improved, the problem of a complete prevention of ischemic spinal cord injury on the thoracoabdominal aortic operations remains unsolved. The multimodality approach is needed to reduce the risk of this devastating complication.

Effects of skin pressure applied by cuffs on resting salivary secretion

The effects of pressure applied by cuffs to the abdomen, thighs and legs on resting salivary flow rate and digestive function of saliva were investigated in 9 healthy female students, aged 18 to 33 yrs (Experiment I) in a climatic chamber (Ta: 28 degrees C, RH: 50%). Each participant changed from street clothing into loose-fitting experimental garments so as to avoid any skin pressure on the body, and sat calmly in a reclining chair throughout the experimental period (195 min). After 90 min (FREE period), the physiological effects of skin pressure applied by their own clothing disappeared, and skin pressure was applied for the next 60 min to the abdomen (40 mmHg) and thighs (40 mmHg) then to the legs (60 mmHg) by the use of air-inflated cuffs (PRESSURE period). During the next 45 min, the skin pressure was again removed by letting the air of the cuffs out (FREE' period). The resting salivary flow rate was significantly suppressed while the skin pressure was applied by the cuffs. The digestive time for starch investigated in terms of the iodine starch reaction was longer with the skin pressure than without. The concentration of amylase measured in 20 female participants aged 21 to 23 yrs, decreased with skin pressure applied by the usage of the rubber tape (Experiment II). These results suggest that the pressure applied to the body can influence the digestive response by decreasing the amount of saliva via the autonomic nervous system.

[Detection of coronary artery disease by adenosine triphosphate stress echocardiography: comparison with adenosine triphosphate stress thallium myocardial scintigraphy and coronary angiography]

The clinical feasibility and usefulness of adenosine triphosphate-2Na (ATP) stress echocardiography for the detection of coronary artery disease (CAD) were assessed. Two-dimensional echocardiography and thallium-201 single photon emission computed tomography (SPECT) during ATP infusion were performed simultaneously in 58 consecutive patients (41 men and 17 women; mean age 66 +/- 12 years) with suspected CAD. ATP was infused intravenously at 0.16 mg/kg/min for 5 min and thallium was injected at 4 min. All patients underwent coronary angiography within 2 weeks of ATP echocardiography and ATP SPECT. An ischemic response during ATP infusion was detected by echocardiography as the development or worsening of a wall motion abnormality compared with the baseline and by SPECT as a perfusion defect that filled totally or partially during redistribution. Significant coronary artery stenosis was defined as > or = 75% diameter stenosis in a major epicardial vessel. The severity of the stenosis was classified as follows: Group A, lesions with significant coronary artery stenosis (> or = 75%, < 90%); Group B, lesions with severe coronary artery stenosis (> or = 90%) without collateral circulation; Group C, lesions with severe coronary artery stenosis (> or = 90%) with collateral circulation. Significant CAD was present in 43 of 58 patients. The overall sensitivity, specificity and accuracy of ATP echocardiography for detecting significant CAD were 70%, 100% and 78%, respectively, and those of ATP SPECT were 98%, 87% and 95%, respectively. In patients without previous myocardial infarction, the sensitivity of ATP echocardiography was 67%. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia were 59% and 95% in patients with 1-vessel disease, 75% and 100% in those with 2-vessel disease, and 88% and 100% in those with 3-vessel disease, respectively. The induction of wall motion abnormality by ATP echocardiography was highly concordant with ATP SPECT imaging in patients with multivessel disease. Although the sensitivity of ATP echocardiography improved in patients with multivessel disease more than in those with single-vessel disease, detection of all diseased vessels was achieved in only 10% of patients with multivessel disease. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in individual vessels were: right coronary artery, 58% and 74%; left anterior descending artery, 59% and 97%; left circumflex artery, 27% and 68%. ATP-induced transient perfusion defects were associated with transient wall motion abnormality in only 57% of segments. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in patients with severe coronary stenosis were: Group A, 32% and 66%; Group B, 60% and 93%; Group C, 80% and 95%. The sensitivity of ATP echocardiography was significantly higher in the lesions with collateral circulation than in those without collateral circulation. ATP stress echocardiography is useful for detecting myocardial ischemia in patients with multivessel disease and in patients with severe coronary artery stenosis (> or = 90%). In particular, transient wall motion abnormality tends to be detected in the segments perfused by collateral circulation.

[Transferability of cefozopran to cerebrospinal fluid in rabbits with meningitis caused by Staphylococcus aureus]

The transferability of cefozopran (CZOP) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean plasma concentration was 293 +/- 17.6 micrograms/ml at 15 minutes after intravenous administration of CZOP at a dose level of 100 mg/kg. The mean concentration in CSF reached its maximum, 16.5 +/- 2.74 micrograms/ml at 60 minutes after administration. Pharmacokinetic parameters calculated from these values were as follows: Cmax (CSF/plasma) 5.72%, AUC (CSF/plasma) 6.61% between 15 and 60 minutes, 9.38% between 15 and 120 minutes and 11.2% between 15 and 180 minutes, T 1/2 for CZOP in CSF: 138 minutes, T 1/2 (CSF/plasma): 2.81. In comparison to those of beta-lactams that were obtained in the same way, the transferability of CZOP to CSF was moderate but concentration in CSF was high, hence, in consideration of the antimicrobial potency against the main pathogens of meningitis, it appears worthwhile of running clinical trials for CZOP.

[Clinical studies on cefozopran in pediatrics]

Cefozopran (CZOP) was administered via intravenous injection to 9 patients (ages ranging from 1 month to 13 years) with pediatric bacterial infections, at daily dose levels between 56.7 and 200 mg/kg, divided into 3 or 4 doses. The following results were obtained. 1. Eight patients, including 1 with purulent meningitis, 1 with sepsis, 3 with acute pneumonia and 3 with lymphadenitis, were treated and subjected to clinical evaluation. Clinical effects were excellent in 6 cases and good in 2, with an overall efficacy rate of 100%. One case with pyoderma was not evaluated because of a combined use of an external antibiotic. 2. Organisms suspected as pathogens included 5 strains: 3 strains of Haemophilus influenzae, 1 strain of Staphylococcus aureus and 1 of Escherichia coli. Bacteriologically, all the strains were eradicated. 3. Side effects or abnormal laboratory test results were observed in 4 cases; wheal in 1 case, elevated GOT and GPT in 2 cases and eosinophilia in 1 case. 4. From the results described above, we considered that CZOP would be an effective drug for use in pediatric bacterial infections.

[Transferability of biapenem (L-627) to cerebrospinal fluid in rabbits with meningitis caused by Staphylococcus aureus]

The transferability of biapenem (L-627) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean plasma concentration was 192 +/- 12.8 micrograms/ml at 15 minutes after intravenous administration of the drug at a dose level of 100 mg/kg. The mean concentration in CSF was maximum at 45 minutes after administration at 11.4 +/- 2.19 micrograms/ml. Pharmacokinetic parameters calculated from these values were as follows, Cmax (CSF/plasma): 5.96%; AUC (CSF/plasma): 8.15% between 15 and 60 minutes, 12.1% between 15 and 120 minutes and 15.0% between 15 and 180 minutes; T1/2 for L-627 in CSF: 152 minutes; T1/2 (CSF/plasma): 3.34. In comparison with those of other beta-lactam antibiotics that were obtained in the same way, the transferability of L-627 was intermediate, and in consideration of the antimicrobial potency against the main pathogens of meningitis, it appears worthwhile of running clinical trials for this drug.

Human tail associated with lipomeningocele--case report

A 3-month-old boy presented with a tail associated with lipomeningocele. Computed tomography and magnetic resonance imaging clearly demonstrated the presence of spina bifida and lipoma continuous from the tail to the thickened conus medullaris. The human tail may be related to spinal dysraphism and requires detailed neuroimaging investigation, and possibly microsurgery to prevent the tethered cord syndrome.

[Clinical studies of S-1108 granules in the pediatric field]

We studied the clinical use of S-1108 granules in the pediatric field. The results are summarized as follows. 1. S-1108 was administered orally at doses ranging 6.85 and 17.6 mg/kg/day t.i.d. to 9 patients, including 5 cases of pharyngitis and 1 case each of lacunar tonsillitis, bronchitis, pneumonia and urinary tract infection. Clinical efficacies were excellent in 4 cases and good in 5 cases, hence an efficacy rate of 100% was obtained. 2. Haemophilus influenzae, Haemophilus parainfluenzae (2 strains each) and Streptococcus pyogenes, Staphylococcus aureus, Escherichia coli and Enterococcus faecalis (1 strain each) were identified in these cases. Seven of the 8 strains were eliminated upon treatment and the other strain was decreased, hence an eradication rate of 87.5% was obtained. 3. Side effects observed were 1 case each of soft stools and diarrhea. As an abnormal laboratory test result, an increase in GPT level was observed. 4. No refusal of the drug occurred. 5. From the above results, we consider that this drug would be a useful new oral antibiotic for the pediatric field.

[Transferability of vancomycin to cerebrospinal fluid in rabbits with meningitis caused by Staphylococcus aureus]

The transferability of vancomycin (VCM) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. VCM was administered intravenously for 30 minutes at a dose level of 30 mg/kg. Serum concentration reached a maximum of 75 +/- 3.80 micrograms/ml (mean +/- S.E.) at the completion of administration (i.e., 30 minutes) and CSF concentration reached a maximum of 2.4 +/- 0.39 micrograms/ml at 60 minutes. Pharmacokinetic parameters calculated from this concentration-time curve were as follows: Cmax (CSF/Serum) 3.21%, AUC (CSF/Serum) 2.39% between 15 and 60 minutes, 3.99% between 15 and 120 minutes, and 4.40% between 15 and 150 minutes. T 1/2 for VCM in CSF: 143 minutes, T1/2 (CSF/Serum):2.09. Based on this investigation, VCM appears to be effective in the treatment of meningitis caused by MRSA (Methicillin-resistant S. aureus).

[Clinical studies on cefprozil granules]

Cefprozil granule preparation was administered orally to 16 patients (ages ranging 8 months to 9 years and 6 months) with pediatric bacterial infections at daily dose levels between 29.4 and 35.7 mg/kg divided into 3 or 4 doses. The following results were obtained. 1. Sixteen patients including 5 with pharyngitis, 3 with tonsillitis, 3 with lacunar tonsillitis, 2 with pneumonia, 2 with contagious impetigo and 1 with scarlet fever were treated. Clinical effects were excellent in 9 cases and moderate in 7, with an overall efficacy rate of 100%. 2. Organisms suspected as pathogens included 17 strains (10 strains of haemophilus influenzae, 2 of Haemophilus parainfluenzae, 3 of Streptococcus pyogenes and 2 of Staphylococcus aureus). Bacteriologically, eradication of pathogens were observed for 11 strains, but no changes were obtained for 5 (all Haemophilus), and unknown results were obtained for 1, thus the eradication rate was 68.8%. 3. No side effects were observed. Abnormal laboratory test results included 2 cases of increase in platelets, and 2 of increase in eosinophils, but those were not significant. 4. No refusal of the drug occurred due to its taste or odor.

[Studies on meropenem in the field of pediatrics]

The pharmacokinetics and the clinical effectiveness of meropenem (MEPM) were examined in the field of pediatrics. The results are summarized as follows. 1. A 4-year-6-month-old girl with suppurative meningitis (Haemophilus influenzae) was treated by intravenous drip infusion of MEPM in a daily dose of 29 mg/kg which was divided into 4 dosages, each dosage being infused over 30 minutes, and the drug concentration in cerebrospinal fluid was determined. Upon completion of infusion on the 2nd day of treatment, the drug concentration was 2.52 micrograms/ml, which corresponded to 3.6% of the drug concentration in the blood. 2. MEPM was used in 10 patients, including 3 with suppurative lymphnoditis, 2 with staphylococcal scalded skin syndrome (SSSS) and 1 each with pneumonia, suppurative meningitis, suppurative knee arthritis, facial phlegmon and pyelonephritis. The daily doses ranged from 30 to 117.6 mg/kg, divided into 3 to 4 dosages and administered via intravenous drip infusion over 30 minutes. Clinical responses were evaluated as very good in 7 patients, good in 2 patients and fair in 1 patient, with an efficacy rate of 90%. 3. Isolated pathogens were 2 strains of Staphylococcus aureus, 1 strain of Klebsiella pneumoniae and 3 strains of Haemopilus influenzae. All of the 6 strains were eradicated, with an eradication rate of 100%. 4. In the safety evaluation, none of the patients was observed to have any side effects. Furthermore, no abnormal variations were found in laboratory test data possibly attributable to administration of MEPM.

[Transferability of meropenem to cerebrospinal fluid in rabbits with meningitis caused by Staphylococcus aureus]

The transferability of meropenem (MEPM) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean serum concentration was 93.1 +/- 13.5 micrograms/ml at 15 minutes after intravenous administration of MEPM at a dose level of 100 mg/kg. The mean concentration in CSF was maximum at 15 minutes after administration at 4.42 +/- 2.24 micrograms/ml. Pharmacokinetic parameters calculated from these values were as follows: Cmax (CSF/serum) 4.75%, AUC (CSF/serum) 10.4% between 15 and 60 minutes, 13.9% between 15 and 120 minutes and 15.7% between 15 and 180 minutes, T 1/2 for MEPM in CSF: 50.9 minutes, T 1/2 (CSF/serum): 2.19. In comparison to those of imipenem which were obtained in the same way, the transferability of MEPM was similar and in consideration of the antimicrobial potency against the main pathogens of meningitis, it appears worth-while of running clinical trials for this drug.

[Clinical evaluation of flomoxef in neonatal infections]

Serum concentrations, urinary excretion and clinical responses of flomoxef (FMOX) were studied. The results are summarized as follows. 1. Serum concentrations of FMOX were 17.4 micrograms/ml 1-hour after intravenous injection on the average in 5 cases who received approximately 10 mg/kg, 41.8 micrograms/ml in 2 cases given 20 mg/kg, and 69.6 micrograms/ml in 2 cases given 40 mg/kg, indicating that serum concentrations of FMOX changed in a dose-dependent manner in this range. Average serum half-life (T 1/2) in 4 mature babies was 2.48 hours and that in 6 premature babies was 3.17 hours, indicating that elimination rates in premature cases tend to be slower than those in mature cases. Urinary recovery rates averaged 39.2% in the first 6 hours in 5 cases examined. 2. Five newborns or premature babies received FMOX 33.1-80.2 mg/kg (b.i.d. or t.i.d.) via intravenous route for 5 to 8 days. FMOX showed excellent or good clinical effectiveness in the treatment of all patients including 1 case each of sepsis with urinary infection, furunclal otitis, impetigo, uterogenic fetus infection and urinary infection. Bacteriological responses were also studied, and eradication of identified organisms (Escherichia coli 3 strains and Staphylococcus aureus 2 strains) was obtained upon the FMOX treatment, but in 1 strain of S. aureus showed only a decrease. No adverse reactions were observed in any cases, but a slight elevation of eosinophil was noted in 1 patient receiving a dose of 210 mg a day. From the results obtained in these tests, FMOX appears to be very usefull and safe for the treatment of some infectious diseases in neonates.

[Changes in cardiac output during exercise in patients with hypertrophic cardiomyopathy: the study of these influences on exercise intolerance]

In order to investigate the relation between exercise intolerance and cardiac output (CO) increase during exercise in patients with hypertrophic cardiomyopathy (HCM), submaximal treadmill exercise (Sheffield protocol) with simultaneous measurement of CO and oxygen uptake (VO2) by acetylene rebreathing method were performed in twelve patients with HCM who had no demonstrable left ventricular outflow obstruction and fifteen control men. The measurements were made at rest, during exercise and recovery. 1) At rest cardiac index (CI) in patients with HCM was significantly less than in control subjects but the difference was small (HCM: 1.9 +/- 0.35 l/min/m2 vs control: 2.2 +/- 0.38, p less than 0.05), and was almost the same during light exercise (stage 1-3), but clearly increased during middle to submaximal stages (stage 4 and 5) (stage 5: 4.5 +/- 1.25 vs 8.0 +/- 1.30, p less than 0.01). 2) Heart rate was not different in both groups at rest, during exercise and recovery, which was considered to explain that the difference of CI was derived from that of stroke index (SI). 3) The change of VO2 showed the same tendency as that of CI. The difference increased considerably during the middle to submaximal stages (Stage 5: 15.3 +/- 1.42 ml/min/kg vs 25.4 +/- 4.42, p less than 0.01). 4) During recovery, CI and VO2 in patients with HCM indicated a delay of beginning to decrease toward the rest level, compared with control subjects. 5) VO2 was closely related to CI (r = 0.90, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetic and clinical studies of cefpirome in pediatric field]

We conducted a study on the pharmacokinetics and clinical application of cefpirome (CPR) in children. 1. A single intravenous injection of 20 mg/kg of CPR was given to a two-month-old boy, and the concentration of the drug in the blood was measured. Fifteen minutes after administration, the concentration was 53.3 micrograms/ml, and it gradually decreased thereafter, reaching a level of 5.18 micrograms/ml after 8 hours with a half-life in the plasma of 2.36 hours. 2. A single intravenous injection of 700 mg (50 mg/kg) of CPR and that of cefotaxime (CTX) were given to a girl with suppurative meningitis (3 years old, 14 kg, causative bacteria, Haemophilus influenzae), and concentrations of the drugs in plasma and cerebrospinal fluid after 1 hour were measured. On the second day of illness, the concentration of CTX in the plasma was 39.4 micrograms/ml and the concentration of desacetyl-CTX (D-CTX) was 25.2 micrograms/ml, while concentrations in the cerebrospinal fluid were 6.22 micrograms/ml (15.8%) for CTX and 3.94 micrograms/ml (15.6%) for D-CTX. On the third day of illness, concentration of CPR in the plasma was 59.3 micrograms/ml, while its concentration in the cerebrospinal fluid was 7.44 micrograms/ml (12.5%). 3. CPR was intravenously administered in daily dosages of 37.7-75.0 mg/kg in 2-3 portions for periods of 4-15 days to 2 patients with septicemia (causative bacteria, Klebsiella pneumoniae in 1 case and Escherichia coli in the other), 1 patient with bronchitis (K. pneumoniae), 9 patients with pneumonia (1 case of Staphylococcus aureus, 3 cases of H. influenzae, 2 cases of Haemophilus parainfluenzae, 1 case of K. pneumoniae + Pseudomonas cepacia, 2 cases of H. influenzae + Branhamella catarrhalis), 2 patients with cellulitis (1 case of S. aureus, 1 case, causative agent unknown), 1 patient with suppurative lymphadenitis (causative agent, unknown), 1 patient with staphylococcal scalded skin syndrome, 1 patient with renal abscess (causative agent, unknown), and 1 patient with a urinary tract infection (E. coli), for a total of 18 patients, with excellent results in 9 cases and good results in 9 cases, hence an efficacy rate of 100% was obtained. 4. As an accompanying side-effect, eruption was observed in 1 of the 18 patients, but when administration was discontinued, the symptom gradually receded, and it disappeared by the 4th day.(ABSTRACT TRUNCATED AT 400 WORDS)

[Transferability of cefpirome to cerebrospinal fluid of rabbits with meningitis caused by Staphylococcus aureus]

The transferability of cefpirome (HR810, CPR) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean serum concentration was 362 +/- 6.63 micrograms/ml at 15 minutes after intravenous administration of the drug at a dose level of 100 mg/kg. The mean concentration in CSF was maximum at 60 minutes after administration, and the mean maximum concentration was 14.6 +/- 2.85 micrograms/ml. Pharmacokinetic parameters calculated from these values were as follows, Cmax (CSF/serum): 4.04%; AUC (CSF/serum): 5.14% between 15 and 60 minutes, 8.12% between 15 and 120 minutes and 10.4% between 15 and 180 minutes; T 1/2 for CPR in CSF: 154 minutes; T 1/2 (CSF/serum): 3.96. In comparison to those of other beta-lactam antibiotics which were obtained in the same way, the transferability of CPR was intermediate, but the peak CSF level was high, and in consideration of the antimicrobial potency against the main pathogens of meningitis, it appears worthwhile of running clinical trials for this drug.

[Clinical studies on norfloxacin in the field of pediatrics]

We studied clinical effects of norfloxacin (NFLX, AM-715) tablets. The results we found are summarized as follows: 1. Ten patients with 5 diseases were medicated with 7.0-14.8 mg/kg of the drug 3 times daily for 6-8 days. They consisted of one-each with tonsillitis, pharyngitis, bronchitis, 4 with Campylobacter enteritis, 3 with other enteritis. Clinical responses to the treatment were excellent in 8, good in 1 and fair in 1, with an efficacy rate of 90%. Bacteriologically, of 9 isolates for which changes in populations were followed, 6 were eradicated and 3 remained unchanged, with an eradication rate of 66.7%. 2. No. adverse reactions nor abnormal laboratory test values attributable to the drug were observed. 3. These results suggest that this new quinolone drug may be useful, against bacterial infections in children 6 years and older.

[Clinical evaluation of cefmenoxime in infections of neonates]

Cefmenoxime (CMX) was evaluated for its absorption and excretion as well as for therapeutic effectiveness in neonates and premature infants. The following results were obtained. 1. Serum concentrations of the drug were examined in 3 premature infants 1 to 11 days old upon intravenous administration of about 10 mg/kg body weight (1st group), in 2 premature infants 18 and 32 days old and 1 neonate 17 days old upon intravenous administration of about 20 mg/kg (2nd group), and in 1 neonate 15 days old with meningitis upon intravenous administration of 45.2 mg/kg. Concentrations of CMX at 30 minutes after administration were 43, 29 and 27 micrograms/ml, respectively, in the 1st group, 46, 37 and 44 micrograms/ml, respectively, in the 2nd group and 208 micrograms/ml in the other neonate, and appeared to be dose-dependent. Concentrations of CMX at 6 hours after administration were 18.2, 6.6 and 8.1 micrograms/ml, respectively, in the 1st group, 9.6, 11 and 1.35 micrograms/ml, respectively, in the 2nd group and 5.2 micrograms/ml in the other subject. Serum half-lives were, respectively, 4.59, 2.85 and 3.48 hours in the 1st group, 2.52, 2.73 and 1.14 hours in the 2nd group and 1.0 hour in the other subject. Urinary recovery rates during the first 6 hours after administration were 45.8, 87.0, 50.2 and more than 100% in 4 cases examined. Two of these cases, in which recovery rates were 45.8 and 50.2%, were premature infants of low birth weight. Spinal fluid concentrations of the drug at 80 to 90 minutes after dosing to 1 neonate with purulent meningitis (causative organism presumed: Escherichia coli) given 48.3 mg/kg tended to decline gradually with the recovery of the disease, 3.8, 1.72 and 1.32 micrograms/ml on the 2nd, 6th and 8th day, respectively. 2. The drug was given to 9 neonates 0 to 24 days old. The therapeutic effectiveness on bacterial infections was evaluated in 7 cases (10 diseases) including 1 disease of purulent meningitis presumably caused by E. coli, 4 of septicemia caused by E. coli, Staphylococcus aureus and Streptococcus agalactiae (1, 2 and 1, respectively), 3 of urinary tract infection caused by E. coli, Serratia and Enterococcus faecalis (1 each), 1 of purulent parotitis caused by S. aureus and 1 of pneumonia (causative organism was unknown). Therapeutic efficacies were assessed as "Excellent" in all of meningitis, septicemia and urinary tract infection cases, and "Good" in 1 each of purulent parotitis and pneumonia cases.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical studies on cefpodoxime proxetil dry syrup in the field of pediatrics]

Cefpodoxime proxetil (CPDX-PR, CS-807) dry syrup was administered orally to 31 patients with various infections at daily dose levels between 5.4 and 10.9 mg/kg divided into three doses. 1. The subjects were 3 patients with urinary tract infections, 25 with tonsillitis and 1 patient each with bronchitis, pneumonia, and cervical lymphadenitis. Clinical effects were excellent in 16 cases, good in 14, and fair in 1 (tonsillitis), with an overall efficacy rate of 96.8%. 2. Organisms suspected as pathogens were 32 strains (6 strains of Staphylococcus aureus, 2 of Streptococcus pyogenes, 1 of Enterococcus faecalis, 15 of Haemophilus influenzae, 5 of Haemophilus parainfluenzae and 3 of Escherichia coli). Bacteriologically, eradication of pathogens were observed in 30 strains, decrease in one (H. parainfluenzae), and no change in another (E. faecalis), thus the eradication rate was 93.8%. 3. Side effect was observed in 1 case (slight eruption) but it was possible continue the treatment. Abnormal laboratory test values were observed in 1 case of a slight prolongation of prothrombin time and eosinophilia, but they were not serious. Diarrhea was not observed in any patients. 4. All the medication was done on schedule. No refusal of the drug occurred due to its taste or odor.

[Experimental study on transferability to cerebrospinal fluid of cefodizime in combination with ampicillin]

A study was done on cefodizime (THR-221, CDZM) in combination with ampicillin (ABPC) for its transferability to cerebrospinal fluid (CSF) of rabbits with experimental meningitis caused by Staphylococcus aureus. Blood and CSF were collected at 15, 30, 45, 60, 90, 120 and 180 minutes after intravenous administration of CDZM at 100 mg/kg to 6 rabbits, ABPC at 100 mg/kg to 4 rabbits and simultaneous administration of both drugs at 100 mg/kg each to 5 rabbits. Drug concentrations were assayed with an high performance liquid chromatography method, and pharmacokinetic parameters were calculated. The comparison revealed no significant difference in concentrations achieved among different groups. Therefore, the mutual transferability of these drugs to CSF was not considered to interact adversely due to the simultaneous administration of both drugs. Accordingly, CDZM may be a candidate of chemotherapeutics in the therapy of purulent meningitis, and it is worthy of further investigations.

[Transferability of cefodizime to cerebrospinal fluid of rabbits with meningitis caused by Staphylococcus aureus]

The transferability of cefodizime (THR-221, CDZM) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean blood concentration was 195 +/- 18.3 micrograms/ml using phosphate buffer solution (PBS) standard and 474 +/- 22.0 micrograms/ml using rabbit serum standard, respectively, at 15 minutes after intravenous administration of the drug at a dose level of 100 mg/kg. The mean concentration in CSF vs. PBS standard was maximum at 60 minutes after administration, and the mean maximum concentration was 8.74 +/- 2.16 micrograms/ml. Pharmacokinetic parameters calculated from those values were as follows, respectively, for PBS standard and rabbit serum standard; Cmax (CSF/serum): 4.48% and 1.84%. AUC (CSF/serum): 6.15% and 2.02% between 15 and 60 minutes, 10.6% and 3.00% between 15 and 120 minutes and 13.4% and 3.48% between 15 and 180 minutes. T 1/2 for CDZM in CSF: 141 minutes in both cases. T 1/2 (CSF/serum): 3.27 and 2.11. Concentrations in CSF determined using an high performance liquid chromatography method in another rabbits were similar to those determined using the bioassay vs. rabbit serum standard. The bioassayed concentration of this drug (AUC (CSF/serum] vs. PBS standard ranked 9th among 23 other beta-lactam antibiotics tested. That is, the drug distributed favorably as compared to other antibiotics, and it may be worthwhile of running clinical trials on this drug in meningitis when antimicrobial potential against main pathogens of meningitis are considered.

[Bacteriological, pharmacokinetic and clinical studies of sulbactam/ampicillin in the pediatric field]

The usefulness of sulbactam/ampicillin (SBT/ABPC) in the treatment of pediatric infections was evaluated. 1. Twenty pediatric patients with infection were treated with SBT/ABPC and an intravenous dosage of 27.8-47.4 mg/kg, 3 to 4 times a day. Clinical efficacies in 18 patients excluding 2 patients of Mycoplasma pneumonia (9 cases of pneumonia, 6 urinary tract infection, 1 tonsillitis, 1 maxillary sinusitis and 1 osteomyelitis) were judged to be excellent in 13 patients and good in 5. There was no case of failure. 2. Bacteriological efficacies against 16 strains (1 Staphylococcus aureus, 3 Enterococcus faecalis, 4 Haemophilus influenzae, 2 Haemophilus parainfluenzae, 5 Escherichia coli and 1 Serratia sp.) isolated from 13 of the 18 patients were rated as "eradicated" for 13 strains, "decreased" for 1 and "unchanged" for 2 with an eradication rate of 81.3%. Of 13 strains eradicated, 3 were those with high beta-lactamase productivity. 3. Rash as a side effect developed in 1 patient and eosinophilia and elevated GOT and GPT were observed in 7 patients but none of them were serious. 4. Blood levels of the drug following an intravenous dose of 30 mg/kg were determined in 2 pediatric patients. Blood levels of SBT and ABPC at 30 minutes after intravenous administration were 19.0 and 29.2 micrograms/ml in one patient and 21.0 and 31.6 micrograms/ml in another, respectively, and those at 4 hours were 0.48 and 0.62 microgram/ml in one patient and 0.59 and 0.89 microgram/ml in another, respectively. The half-lives of SBT were 0.67 and 0.70 hour and those of ABPC were 0.64 and 0.69 hour in the 2 patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical experience with sultamicillin fine granules in pediatric field]

Sultamicillin fine granules were used orally in 18 pediatric patients with infections in doses ranging 7.3-10.0 mg/kg t.i.d. or q.i.d. The following is a summary of the results: 1. Clinical efficacies in 16 cases with tonsillitis were excellent in 13 cases, good in 2 cases and fair in 1 case. Efficacy in 1 case of bronchitis and 1 case of pneumonia were good. The overall efficacy rate in the 18 cases was 94.4%. 2. Four out of 5 strains of Staphylococcus aureus were eradicated but 1 strain persisted. Three out of 7 strains of Haemophilus influenzae were rated as eradicated, 1 strain as decreased and 3 strains as persisted. Two strains of Streptococcus pyogenes and 3 strains of Haemophilus parainfluenzae were eradicated. The bacteriological efficacy rate for the 17 strains was 70.6%. Four strains out of the 17 were found to produce beta-lactamase and 3 strains were suspected, to produce the enzyme, but of these 7 strains, 5 strains were eradicated. 3. Diarrhea and loose stool were observed as side effects in each of 2 cases. It appeared that diarrhea was related to this drug. A slight elevation of GOT was observed in 1 case in laboratory tests. 4. This drug appears to be easy for children to take in terms of taste and smell.

Drug transfer into cerebrospinal fluid after simultaneous administration of ampicillin with ceftriaxone or ceftazidime in rabbits with Staphylococcus aureus meningitis

Meningitis was induced in white rabbits with a non beta-lactamase producing strain of Staphylococcus aureus. There was no significant difference in the CSF level of ceftazidime after simultaneous administration of ceftazidime with ampicillin or after ceftazidime alone. In contrast the percentage CSF penetration of ampicillin decreased from 8.81% after administration of ampicillin alone to 2.77% after the simultaneous administration of ampicillin with ceftazidime. The ratio of AUC in CSF and serum was 19.4% after ampicillin alone and 7.71% after simultaneous administration with ceftazidime. When ceftriaxone was combined with ampicillin there was no effect on the CSF penetration of either drug. Cephalosporins have unpredictable effects on the CSF concentration of ampicillin, probably due to variable effects on the penetration of ampicillin from blood to CSF.

[Clinical studies of rokitamycin dry syrup in the field of pediatrics]

We studied the absorption and excretion as well as the clinical effect of rokitamycin (RKM, TMS-19-Q) dry syrup. The results we found are summarized as follows: 1. When 3 pediatric patients were medicated orally with a single dose of 10 mg/kg of the drug, its peak concentrations of 0.75 and 0.51 microgram/ml appeared in the blood in 30 minutes after administration in 2 patients, and of 0.21 microgram/ml in 1 hour in the other patient. At 4 hours after administration, its concentration in the blood was 0.07-0.08 microgram/ml in all of the patient, and at 6 hours, it was undetectable. T1/2 values were 1.05-2.08 hours. First 6-hour urinary recovery rates of the drug in the first 2 patients were 1.52 and 1.11%, respectively. 2. Twenty-four patients with 25 diseases were medicated with 7.14-12.5 mg/kg of the drug 3-4 times daily for 4-10 days. The patients consisted of 12 with tonsillitis, 7 with bronchitis, 3 with colitis, one each with Haemophilus influenzae pneumonia, mycoplasmal pneumonia, and pertussis. Clinical responses to the treatment were excellent in 7, good in 13, and poor in 5, with an efficacy rate of 80.0%. Bacteriologically, of 17 isolates whose changes were followed, 8 were eradicated, 1 decreased, and 8 remained unchanged, with an eradication rate of 47.1%. 3. No adverse reactions to the drug were observed in any of these patients, while abnormal laboratory test values observed were slight eosinophilia and also slight elevations of S-GOT and S-GPT in one of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of ceftriaxone in the treatment of neonatal infections]

Ceftriaxone (CTRX) was administered to the newborn and its clinical effectiveness as well as its blood and cerebrospinal fluid levels were studied. 1. Average blood levels of CTRX 1 hour after single intravenous administration were 39 micrograms/ml in 2 cases receiving about 10 mg/kg, 70 micrograms/ml in 2 other cases receiving 20 mg/kg and 208 micrograms/ml in one receiving 52.6 mg/kg. As is apparent from these cases data, blood levels of CTRX were dose dependent. Blood levels of the drug were between 3.7 to 12.4 micrograms/ml 24 hours later. Half-lives of the drug in blood in the 5 newborns ranged from 7.13 to 10.6 hours. In a 53-day-old patient receiving 43.4 mg/kg of CTRX via intravenous injection, the one-hour blood level of the drug was 140 micrograms/ml and the half-life was 3.68 hours. The blood level of the drug 36 hours after single intravenous administration with 17.3 to 20.0 micrograms/ml to 5 other cases 0 to 5 days of age ranged from 4.6 to 13.7 micrograms/ml. 2. The cerebrospinal fluid level of CTRX 4 hours after intravenous administration with 49.6 mg/kg to cases of Escherichia coli meningitis was 9.7 micrograms/ml on the first day following the start of the treatment. It increased to 23.6, 25.2 and 31.0 micrograms/ml on the third, fourth and fifth days, respectively, and then gradually decreased. Cerebrospinal level was still 5.8 micrograms/ml on the 22nd day during the recovery period. These levels were far more than 1,000 times as much as the MIC for the pathogen at the highest level, and more than 100 times even at the lowest level. 3. CTRX was administered via intravenous injection once or twice a day (11.0-39.5 mg/kg in total) to 13 newborns and 3 infants. The efficacy of CTRX was good to excellent in 10 cases for treatment of 11 diseases (sepsis 1, pneumonia 4, urinary tract infection 4 and fetal infection 2) and all the pathogens (Streptococcus agalactiae 1, E. coli 3, Klebsiella pneumoniae 2, Citrobacter diversus 1) disappeared. In 6 cases where CTRX was used prophylactically, infection did not occur at all. The efficacy was excellent in another newborn with E. coli meningitis intravenously receiving 49.6 mg/kg of CTRX twice daily for 25 days. 4. No adverse reactions were observed. Mild eosinophilia was observed in 4 cases. Follow-up examinations of 3 of the 4 cases showed that these abnormal levels were returned to normal.(ABSTRACT TRUNCATED AT 400 WORDS)

[Bacteriological and clinical studies of flomoxef in the pediatric field]

Flomoxef (FMOX, 6315-S), a new parenteral oxacephem antibiotic, was studied bacteriologically and clinically. 1. The MIC and MBC values of FMOX and cefuzonam (CZON) were determined against strains of Staphylococcus aureus recently isolated from clinical materials. In MICs against methicillin- and cefazolin (CEZ)-sensitive strains, FMOX and CZON were almost equivalent. In MBC, FMOX showed lower values than CZON. Against resistant strains, both MIC and MBC values indicated that FMOX was superior to CZON, and particularly, values showed large differences in MBC. 2. FMOX was administered intravenously at doses of 20.0-35.1 mg/kg 3 or 4 times daily to 17 children aged 2 months to 8 years. The therapeutic effect was determined in 16 cases (pneumonia 9 cases, pyothorax 1, urinary tract infection 2, staphylococcal scalded skin syndrome 1, cellulitis 2 and arthritis 1). One remaining case was unevaluable and later found to be mycoplasmal pneumonia. The effect was determined as excellent in 10 cases and good in 6 cases. All the causative organisms detected in these evaluable cases were eliminated. 3. There were no symptoms or findings that suggested the occurrence of side effects of the drug in any of the 17 cases. With regard to laboratory values, a slight elevation of GPT was found in 1 case only. 4. In a case with pyothorax, the concentration of the drug in the pleural fluid determined on the day following the initiation of treatment was 18.2 micrograms/ml at 30 minutes after intravenous injection of the drug at 33 mg/kg. The concentration was 46.7 times as high as the MIC (0.39 micrograms/ml) against the causative organism S. aureus. 5. Two doses of FMOX were intravenously administered at the dose of 50 mg/kg to a female infant ventriculoperitoneal shunt infection which had been treated with other drugs. In this case showing relatively low cell counts of 171-240/mm3 in the ventricular fluid, concentrations of the drug measured by HPLC were as low as 0.53 and 0.98 micrograms/ml 1 hour after intravenous injection of the drug. 6. The above results suggested that FMOX is a new antibiotic drug easy to use and effective for the treatment of general infections in children.

[Investigation on the use of amikacin in the newborn]

The use of amikacin (AMK) in newborns was investigated and the results obtained are summarized as follows. 1. AMK was administered to 3 rabbits at an intramuscular dose of 6 mg/kg. Mean blood levels determined according to methods of bioassay (BIO) and fluorescent immunoassay (FIA) were 28.6 and 22.2 micrograms/ml, respectively, at 30 minutes after dosing. Then, the blood levels declined rapidly. Mean T 1/2 values obtained with the above 2 assay methods were 0.76 and 0.63 hours, respectively. 2. When AMK was administered at a dose of 5.7 mg/kg to a 64 day-old newborn by drip intravenous infusion for 30 minutes, a peak blood level was attained at the end of drip intravenous infusion, which was 20.0 micrograms/ml according to BIO and was 15.5 micrograms/ml according to FIA. The blood levels declined gradually thereafter with a T 1/2 value of 2.33 hours (BIO) or 2.03 hours (FIA). When the drug was administered at 5.3 mg/kg to a 26 day-old newborn using the same infusion method, the peak blood level obtained at the end of drip intravenous infusion was 18.0 micrograms/ml according to BIO and was 14.8 micrograms/ml according to FIA, and T 1/2 values were 4.76 and 3.68 hours, respectively. 3. As there was a close correlation between the values obtained with BIO and with FIA in both rabbits and clinical cases, with a coefficient of 0.990, and also the BIO values could be estimated using a formula of FIA value X 1.2 + 2.2, it would be possible to monitor AMK levels in the blood of patients at bedside using the FIA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of cefuzonam in pediatrics]

Cefuzonam (L-105, CZON), a new injectable cephalosporin, was used in 12 pediatric patients with infections. The following is a summary of the results: The 12 cases included 3 cases of tonsillitis (pathogen: Haemophilus parainfluenzae in 1 case, Haemophilus influenzae in 2 cases), 4 cases of pneumonia (Staphylococcus aureus in 1 case, pathogen unknown in 3 cases), 2 cases of nephropyelitis (Escherichia coli in 2 cases), 1 case of purulent lymphadenitis (pathogen unknown), 1 case of purulent thyroiditis (mixed infection of Streptococcus milleri, Haemophilus aphrophilus and anaerobes), and 1 case of vulvar abscess (E. coli). Dose levels of CZON were 42.9 approximately 93.3 mg/kg/day divided into 3 or 4 times and the drug was intravenously injected for 6 to 12 days. Clinical efficacies were excellent in 4 cases, good in 5 cases, and poor in 3 cases, with the efficacy rate of 75.0%. The 3 cases with poor efficacy consisted of 1 case each of pneumonia complicated with chronic granulomatosis, purulent thyroiditis associated with piriform recess fistula, and purulent lymphadenitis of armpit developed after surgical operation of congenital heart disease. In the first 2 cases satisfactory efficacy was not obtained by chemotherapy alone, and complete cure was seen after surgical operation. Side effects were not observed clinically. One case each of slight prolongation of prothrombin time and transient elevations of GOT and GPT values were noted but no severe abnormalities were found in laboratory tests.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the clinical effects of cefotiam against infections in neonates and premature infants]

Using cefotiam (CTM) against infections in neonates and premature infants, we obtained the following results: With intravenous administration of the drug to 2 cases each of pyoderma, pneumonia, and fetal infection, the drug was effective in all the cases except in 1 premature infant with pneumonia. Dose levels at individual injections were between 18.6 and 27.8 mg/kg, per dose, with an exception in 1 case of pyoderma (36.4-54.5 mg/kg), and 2 to 4 doses per day were given to each patient. For prophylactic purposes, the drug was administered to 1 case of turbid amniotic fluid and 3 cases of massive aspiration syndrome, and no infection was observed in any case. In a total of 11 cases consisting of the above mentioned 10 cases and an additional case which had been excluded from the evaluation because of the detection of P. aeruginosa, neither side effects nor abnormal laboratory values were recognized. In 5 cases of 4 to 31-day old infants, CTM concentrations in blood were measured after one-time intravenous injection of the drug at a dose level of about 20 mg/kg. Blood concentrations of CTM were low in 1 case with levels of 14.4 and 4.5 micrograms/ml at 30 minutes and 2 hours after the intravenous injection, respectively, whereas they were high in another case with readings of 82 and 65 micrograms/ml. In the remaining 3 cases, however, 30-minute and 2-hour values were between 41 to 52, and 13.5 to 22.8 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Penetration of aztreonam and ampicillin to cerebrospinal fluid in the concomitant administration to rabbits with Staphylococcus aureus meningitis]

Aztreonam (AZT) and ampicillin (ABPC) were independently administered to 6 and 7 rabbits respectively, with S. aureus meningitis. Additionally, AZT and ABPC were concomitantly given to 6 rabbits with S. aureus meningitis. Concentrations of AZT and ABPC in cerebrospinal fluid (CSF) and serum were determined by HPLC method, and the results in concomitant treatment were compared with those for single treatment of each agent. Results were as follows: Maximum serum concentrations of AZT in concomitant treatment of AZT and ABPC were higher than those in single treatment of AZT. However, there was no significant difference between the 2 treatment groups with regard to maximum CSF concentration, percentage of AUC of CSF to serum, and T1/2 of the CSF and serum concentrations of AZT. ABPC in the concomitant treatment did not influence the CSF concentration of AZT. There was no significant difference in serum concentration of ABPC between concomitant treatment and the single one. However, the values of maximum CSF concentration, percentage of maximum CSF to serum concentration and percentage of AUC of CSF to serum in the concomitant treatment were lower than those in the single treatment of ABPC. With regard to T1/2 of CSF concentration of ABPC, there was no remarkable difference between the 2 treatment groups. The above results suggest that the distribution of ABPC into CSF is suppressed in the concomitant treatment of AZT and ABPC. AZT has no antimicrobial activity against Gram-positive bacteria. The CSF concentration of ABPC is suppressed in the concomitant treatment. Those facts suggest that AZT should be administered for meningitis cases after the identification of causative pathogens.

[Clinical evaluation of aztreonam in pediatrics]

Clinical studies of aztreonam (AZT) were performed in 10 pediatric cases. One transient pyuria case with 10(3)/ml E. faecalis detected in urine was excluded from clinical evaluation, because the presence of infection was unclear. Results were as follows: AZT was effective on 1 patient with meningitis (causative organism: H. influenzae), who was treated with 41.7 mg/kg 4 times a day. Results of administration of 58.1-78.9 mg/kg 3 or 4 times a day by intravenous injection for 1 E. coli sepsis-and-pyelonephritis complication case and 7 pyelonephritis cases (causative organisms: E. coli in 1, E. coli + E. faecalis in 1, E. faecalis in 1, P. aeruginosa in 3 and unknown in 1) were excellent in 4, good in 2 and poor in 2 cases. The pathogens of the 2 poor cases were E. faecalis and P. aeruginosa, respectively. Six of the pyelonephritis cases had vesicoureteral refluxes as an underlying condition. Clinical and microbiological effects of AZT were considered to be closely correlated with its MIC values. No side effect was recognized. Though abnormal laboratory findings were obtained in 4 cases, including elevations of GOT X GPT in 2 cases, GPT elevation in 1 case and plateletcount increase in 1 case. All of these abnormalities were minor and transient. The serum concentrations of AZT for a two-month-old patient with pyelonephritis were 65, 50, 35, 22.8 and 12.4 micrograms/ml at 1/2, 1, 2, 4 and 6 hours, respectively and T1/2 was 2.42 hours after injecting AZT 20 mg/kg by intravenous injection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bacteriological and clinical evaluation of BRL 25000 (clavulanic acid-amoxicillin) granules in the pediatric field]

Bacteriological and clinical evaluations of BRL 25000 (1 part clavulanic acid plus 2 parts amoxicillin) granules in the pediatric field have been performed. The MICs of BRL 25000 against 25 clinically isolated strains of S. aureus, 40 E. coli, and 14 K. pneumoniae were compared with those of AMPC. Against beta-lactamase non-producing strains of S. aureus and E. coli, the MICs of both drugs were nearly equal, however, against beta-lactamase producing strains of these species and K. pneumoniae, BRL 25000 was superior to AMPC. The blood levels of AMPC and CVA after single oral administration of approximately 15 mg/kg of BRL 25000 granules to fasted children were studied in 3 subjects. The mean levels of AMPC and CVA peaked about 1 hour after administration at values of 11.40 and 5.49 micrograms/ml, respectively, with half-lives of 0.91 and 1.02 hours, and AUCs of 23.52 and 12.66 hr X micrograms/ml, respectively. The 6-hour urinary recovery of AMPC ranged from 30.59% to 52.03% and for CVA from 16.31% to 45.18%. There was no significant difference between the blood level of AMPC following single oral administration of approximately 10 mg/kg AMPC granules and that of AMPC following single oral administration of approximately 15 mg/kg BRL 25000 granules to the same children. Clinical evaluation of BRL 25000 granules administered orally 3-4 times a day at total daily doses of between 42.9-52.9 mg/kg resulted in improvement, judged excellent or good, in all 7 cases of tonsillitis and 2 cases of pyelonephritis. In particular, the clinical effect was excellent in the case of tonsillitis where a beta-lactamase producing H. influenzae was isolated. In the total 11 cases treated, including 2 cases of mycoplasmal pneumonia excluded from the clinical evaluation, 1 case of rash and eosinophilia was observed. No other adverse reactions or abnormal laboratory findings were observed. The taste and flavor of the drug were well accepted by the children. It was concluded that BRL 25000 granules are promising new drug which should be markedly useful in the treatment of infections in pediatric outpatients.

Cerebrospinal fluid penetration after combined administration of cefotaxime and ampicillin to rabbits with staphylococcal meningitis

The pharmacokinetics of cefotaxime and ampicillin in the cerebrospinal fluid (CSF) were studied by a HPLC method after administering each of the antibiotics singly or as a mixture to rabbits with experimental meningitis caused by Staphylococcus aureus. The half-lives of cefotaxime and desacetyl-cefotaxime in the serum and of ampicillin in the CSF were found to be significantly shorter in the mixture group than in the respective single administration groups. No other statistically significant differences were observed between the mixture and single administration groups with respect to the maximum concentrations (Cmax) of the antibiotics in the serum and the CSF, to the relative percentage of the Cmax of each antibiotic in the CSF to the Cmax in the serum, and to the relative percentage of the AUC of each antibiotic in the CSF to that in the serum. These results differ from earlier findings that the concentration of ampicillin in the CSF of rabbits was significantly lower in animals concomitantly dosed with latamoxef (moxalactam) and ampicillin than in a group dosed only with ampicillin.

[Evaluation of latamoxef in the treatment of infections of newborn infants]

The usefulness of latamoxef (LMOX) in the treatment of newborn infants was investigated. The results that were obtained are summarized below. LMOX was injected intravenously in a dose of about 20 mg/kg, and 30 minutes later the concentration of the drug in the serum was determined. In a very low-birth-weight infant, weighing only 978 g at the time of birth, the serum concentration on the 3rd day after birth was 94 micrograms/ml, while it was found to be 100 micrograms/ml when the dosing and determination were performed on the 37th day after birth. Another premature infant weighed 1,980 g at birth, and on the 8th day of life the serum concentration was 73 micrograms/ml. The half-lives of LMOX in these 3 administrations were 4.74, 3.95 and 3.20 hours, respectively. LMOX was administered by intravenous injection to 4 patients diagnosed as having 6 diseases (2 patients each had both septicemia and a urinary tract infection; 1 patient had pneumonia; 1 patient had septicemia). Each dose ranged from about 15 to 25 mg/kg, and 3 doses were administered daily (in 1 patient, 4 doses were given over a 2-day period). The evaluation of the clinical results for each disease case showed 4 excellent cases and 2 poor cases. The 2 poor cases consisted of 1 case of pneumonia caused by S. aureus, and 1 case of a mixed urinary tract infection caused by E. coli and S. faecalis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of cefpiramide in pediatrics]

A clinical study was made of cefpiramide (CPM) a new cephem-type antibiotic for injection and the following results were obtained. Blood level of CPM, after 20 mg/kg administration by drip infusion over a period of 1 hour, reached its peak of 86 micrograms/ml at the end of the infusion and declined to 19.8 micrograms/ml at 4th hour after infusion with the half-life value of 3.02 hours. Its urinary recovery rate up to 9 hours was 29.2% and the urine concentration from 0 to the 3rd hour was 820 micrograms/ml and from the 3rd to the 5th hour 650 micrograms/ml. In another case of the same dose with intravenous administration, the blood level at the end of the first 1 hour reached 56 micrograms/ml and by the 4th hour it had fallen to 20.6 micrograms/ml and by the 6th hour to 13.6 micrograms/ml. The half-life value was estimated as 2.44 hours. CPM was administered in 2 or 3 divided doses at a daily dosage ranging from 41.7 to 62.5 mg/kg by intravenous injection or by 1-hour drip infusion to 6 patients (3 cases of pneumonia, 2 cases of urinary tract infections, 1 case of purulent cervical lymphadenitis) and the following clinical results were obtained; "markedly effective" 3 cases, "effective" 2 cases, and "ineffective" 1 case. The overall efficacy rate was 83.3%. No side-effects or abnormal laboratory findings were found in any of the 7 patients including 1 patient who was excluded from the efficacy evaluation because of Kawasaki's disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of an ampicillin suppository (KS-R1)]

Clinical evaluations of ampicillin (ABPC) suppository (KS-R1) were performed in 9 cases with infectious diseases in the pediatric field and the following results were obtained; When 2.7 mg/kg of KS-R1 was rectally administered to 1 case, the plasma levels of ABPC were 3.9 micrograms/ml at 15 minutes, 2.2 micrograms/ml at 30 minutes and 1.2 micrograms/ml at 60 minutes after administration. The urinary excretion rate within 6 hours was 5.0%. Clinical effects of KS-R1 were examined in 6 cases (4 cases of tonsillitis and 2 cases of urinary tract infection) at the dose of 20 approximately 50 mg/kg/day for 3 approximately 7 days. Clinical responses were excellent in 4 cases, good in 1 case and poor in 1 case (tonsillitis). As to the side effects, slight increase of eosinophil was observed in 1 case, but no diarrhea, perianal redness and eruption were observed. Since discharge ratio of KS-R1 within 5 minutes was 11.0%, the tolerance of KS-R1 was considered to be good. From the above results, KS-R1 is useful for treating the pediatric patients with various infections, who refuse to oral administration or are impossible to give oral administration because of vomiting and are multiple handicapped ones.

[Clinical application of cefotetan in pediatrics]

Clinical evaluation was made on cefotetan (CTT), a new cephamycin antibiotic, and the following results were obtained. Following 6 patients were treated with a daily dose of 31.0-47.5 mg/kg of CTT, which was given in 3 divided doses by an intravenous injection or a 1 hour drip infusion; 2 patients with cystitis (causative organism: E. coli and P. mirabilis, respectively), 3 with pyelonephritis (E. coli in 3) and 1 patient with Salmonella enteritis (S. typhimurium). CTT showed a remarkable therapeutic effect on cystitis and pyelonephritis but was ineffective against Salmonella enteritis. Neither adverse clinical reactions nor abnormal laboratory findings were noted. Based on the above results, CTT is considered to be an appropriate and useful new antibiotic in the treatment of bacterial infections, particularly urinary tract infections in children. The fact that longer duration of blood concentrations has made is possible to give this antibiotic in 2 divided doses will be of great practical benefit.

[Clinical evaluation for T-1982 (cefbuperazone) in the field of pediatric infection]

T-1982 (cefbuperazone), a new injectable cephamycin antibiotic, was employed for bacterial infections in children, and the following results were obtained. 1. When administered intravenously at a dose of 20 mg/kg to a 6-year-old female child, serum levels were 62 micrograms/ml at 30 minutes, 39 micrograms/ml at 1 hour, 17.6 micrograms/ml at 2 hours, 6.8 micrograms/ml at 4 hours and 2.9 micrograms/ml at 6 hours with serum half-life (T 1/2) of 76 minutes. Urinary excretion rates were 41.0, 5.3% and 2.4% respectively at 0-2, 2-4 hours and 4-6 hours, and urinary levels were 820 micrograms/ml, 182 micrograms/ml and 310 micrograms/ml, respectively. The total urinary recovery within 6 hours was 48.7%. 2. A total of 11 cases of pediatric infections was treated with T-1982. The clinical efficacy evaluated for 9 cases, excluding 2 cases of non-bacterial infections, was as follows; excellent in 4, good in 1 out of 5 cases of pneumonia, good in 1 case of cervical purulent lymphadenitis, and excellent in 1, good in 1, poor in 1 out of 3 cases of urinary tract infection. 3. As side effect, mild diarrhea in 1 case and slight elevation of GOT, GPT in 2 cases were observed. 4. These results suggest that T-1982 is of good use for bacterial infections in children and the expected efficacy is obtained at a dose of 20 mg/kg 3 times a day.