複雑性尿路感染症に対するカルモナム(CRMN),ホスホマイシン(FOM) 2剤併用の臨床的検討

Abstract

TUR-Pによる治療を施行した前立腺肥大症患者25例に対してCMNX 1 gをone shot静注し, 1時間後の血清, 前立腺組織内濃度について検討した.1) CMNXの血清濃度は69.17±17.47 μg/ml前立腺組織内濃度は5.33±2.33 μg/g, P/S ratioは8.18±4.45%であった.2)血清濃度と前立腺組織内濃度との間には, 相関は認められなかった.3)前立腺組織内濃度と臨床分離株に対するMIC90との比較により, グラム陰性桿菌が起炎菌である細菌性前立腺炎やTUR-P前後の感染症や感染予防に有効であると考えられた

Carumonam (CRMN), the first monobactam antibiotic in Japan, has excellent activity against gram-negative bacteria and is useful in the treatment of urinary tract infections. However, it may be insufficient in the treatment of complicated urinary tract infections because of the increase in isolation of gram-positive bacteria, and it may be necessary to co-administer antibiotics active against gram-positive organisms to achieve a broader spectrum of coverage in connection with severe infections. The combination of CRMN and fosfomycin (FOM) was evaluated for its effectiveness and safety at the Department of Urology, Yamagata University Hospital and 7 affiliated hospitals. Clinical efficacy was assessed on 64 patients with complicated urinary tract infection according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd. ed.) recommended by the Japan UTI Committee. Clinical efficacy was evaluated as excellent in 16, moderate in 32, poor in 16, with an overall clinical effectiveness rate of 75.0%, which is superior compared with CRMN alone. Of the total of 92 bacterial strains isolated, 66 (71.7%) were eradicated. Subjective adverse reaction was seen in 1 patient (1.4%), as nausea and anorexia. Slight increases in serum GOT and GPT ware recorded in 5 patients (7.1%). These findings disappeared after the termination of administration without treatment. The combination of CRMN and FOM might therefore be useful in the treatment of complicated urinary tract infections.