泌尿器科領域に於けるサイクロセリン(サイクロマイシン)の応用

Abstract

I. Basic Studies Recently, u rinary tract infections by drug resistant bacteria have remarkably increased. They were exclusively gram negative rods, species identified were mostly Escherichia coli (E. coli), Citrobacter, Klebsiella, Cloaca, Proteus and its relatives (Rettgerella and Morganella), Providencia and Pseudomonas (Taxonomy is according to Kaufmann). These rods were mostly resistant to streptomycin (Sm), tetracyclines (Tc), chloramphenicol (Cm), and sulfa drugs (Su). Some of them were resistant even to kanamycin (Km), furadantin (Fd) and colistine (C1). The average resistance of clinical isolates were determined on ordinary nutrient agar plates. The resistance to cycloserine was almost uniform in each species, and indifferent to the resistance to other drugs. In vitro test showed that cycloserine, in concentration of average resistance, lysed bacterial cells in logarithmic growth phase but not in stationary phase. In lower concentrations of cycloserine the growth of cells were inhibited. E. coli and so-called coliform bacilli (Citrobacter, Klebsiella and Cloaca) were most sensitive to cycloserine, with the minimal inhibitory concentrations (MIC) being between 50 and 250 mcg/ml. Proteus and related species were most resistant with the MIC to be 500 mcg/ml or more. Pseudomonas strains were more resistant than coliforms but less than Proteus species. Distr i b ution of this drug in body fluid was estimated. The concentration in serum was relatively low (10 mcg/ml or more), while a considerably high level (200 mcg/ml or more) was obtained in urine. II. Clinical S tudies Clinical obse r v ations were performed in the patients who visited Keio University Hosptital, Urological Clinic. The patients were divided in three groups. 1) Non-complicated acute infections, most of the causative agents were E. coli which were sensitive to ordinary drugs. 2) Gonococci infections. 3) Stubborn infections by drug resistant bacteria. The results showed that cycloserine is very effective in acute infections such as acute cystitis, but had no effect on gonococci. Various effects were noticed in the treatment of infections caused by drug resistant bacteria. Cycloserine was most effective in the infections by E. coli and so-called coliform bacilli (Citrobacter, Klebsiella and Cloaca). In Pseudomonas infections, only 1 of 3 cases was curable. Infections caused by Proteus and related species of bacteria including Providencia were most resistant to this drug. Mild lightheadedness and twitching of muscle were noticed in a few cases, and medication was discontinued with no sequelae.