細菌性前立腺炎に対するsulbactam/cefoperazone(SBT/CPZ)の基礎的検討と臨床成績

Abstract

1) SBT/CPZ 1 g, 2 g点滴投与1時間後のCPZの前立腺液(PF)への移行濃度は0.57, 1.37 μg/mlであり, SBTのそれは0.30, 0.38 μg/mlであった.2)細菌性前立腺炎患者から分離した.E. coli 14株とS. epidermidis 21株に対するMICのピークはそれぞれ0.1～0.2 μg/ml, 0.2～0.78 μg/mlにあり, SBT/CPZの抗菌活性は対照のCPZ, CAZ, PIPCに比し優れていた.3)細菌性前立腺炎患者11例にSBT/CPZ 1日2～4 gを5～8日投与した.急性症には5例中5例, 慢性症6例中評価可能な4例中3例に有効以上の臨床効果をみた.4)副作用を認めなかったが, 1例に一過性の血小板減少を認めた

The cefoperazone and sulbactam concentrations in human prostatic fluid were measured following intravenous administration of sulbactam/cefoperazone (SBT/CPZ) and its clinical efficacy and safety in the treatment of 11 patients with acute or chronic bacterial prostatitis were evaluated. Cefoperazone concentrations in prostatic fluid (PF) one hour after an intravenous infusion of SBT/CPZ at a dose of 1 g and 2 g were 0.57 +/- 0.26 micrograms/ml and 1.37 +/- 0.86 micrograms/ml, respectively, both exceeding the MIC against most of the isolated strains from expressed prostatic secretion (EPS). The sulbactam levels in PF at doses of 1 g and 2 g of SBT/CPZ were 0.30 +/- 0.18 micrograms/ml and 0.38 +/- 0.13 micrograms/ml, respectively, both of which were high enough to potentiate antimicrobial activity of cefoperazone. The peak of MIC distribution of sulbactam/cefoperazone against E. coli (14 strains) and S. epidermidis (21 strains) isolated from EPS of patients with bacterial prostatitis was in a range of 0.1-0.2 micrograms/ml and 0.2-0.78 micrograms/ml as described for the cefoperazone concentration, respectively, which were superior to those of cefoperazone, ceftazidime and piperacillin, all compared as control, SBT/CPZ exhibited 8 fold or more potent antimicrobial activity than cefoperazone against beta-lactamase producing E. coli and CNS. Clinically, SBT/CPZ was given to 11 patients diagnosed as having bacterial prostatitis in a daily dose of 2-4 g for 5 to 8 days. The drug was found to be effective in all (100%) of 5 patients with acute prostatitis and in 3 (75.0%) of 4 patients who were judged to be assessable among 6 chronic patients. No side effects of any kind were observed in any of the patients treated. In laboratory tests, a transient thrombocytopenia was reported for one patient. SBT/CPZ is particularly useful in the treatment of acute bacterial prostatitis caused by GNR. This drug is useful for chronic prostatitis those, caused primarily by CNS which is susceptible to this agent. This drug is available as an injectable form, subjects for its appropriate usage will be those who show acute exacerbation of infection or who do not respond to oral therapy.