前立腺手術後の化学療法: Pivmecillinam (PMPC)による長期治療の効果

Abstract

前立腺肥大症84例, 前立腺癌5例に対し, open surgery(30回)とTUR-P(54回)を施行した術後に, 静注または筋注による初期化学療法を平均5.7日間施行後, Pivmecillinam(PMPC)を2週間以上経口投与し尿路感染を治療した.1) PMPC治療の総合臨床効果判定では, 有効率は2週後60.7%, 4週後74.2%e5～6週後83.3%e7～9週後90.9%e10～14週後100%であった.2)PMPC投与開始前, 尿細菌陽性19例に対するPMPCの有効率は, 2週後47.4%, 4週後53.8%e5～6週後66.7%e7～9週後100%であった.また, PMPC投与前に尿細菌陰性であった70例の有効率は, それぞれ64.3, 79.6, 86.7, 90.0%であった.3)効果なしとし途中でPMPCの投与を中止した例は, 2～4週の間に11例, 5～6週8例あった.うち9例は長期投与で治療効果を得る可能性のある例であった.4)前立腺術後の尿細菌と膿尿の経過は化学療法によりまず尿細菌が消失し, 膿尿の消失には比較的長期間を要した.5)本剤による顕著な副作用はなく, 長期的な化学療法にも適した

The therapeutic efficacy of Pivmecillinam (PMPC) against urinary tract infections after prostatectomy was investigated. PMPC was orally administered at the dose of 300 mg/day for 2-14 weeks after initial intravenous postoperative chemotherapy with other antibiotics for 0-24 days (average 5.7 days). Thirty patients underwent retropubic prostatectomy and the other 59 patients received TUR-P. The chemotherapeutic efficacy for 19 patients who had over 10(3) CFU/ml of microorganisms was as follows: The effective rate was 48.4% after 2 weeks, 53.8% after 4 weeks, 66.7% after 5-6 weeks and 100% after 7-9 weeks. The prophylactic efficacy for 70 patients who had no or less than 10(3) CFU/ml of microorganisms was 64.3% after 2 weeks, 79.6% after 4 weeks, 86.7% after 5-6 weeks and 90.0% after 7-9 weeks. The overall clinical efficacy of PMPC for 89 patients was 60.7% after 2 weeks, 74.2% after 4 weeks, 83.3% after 5-6 weeks, 90.0% after 7-9 weeks and 100% after 10-14 weeks. No severe side effects were found in these 89 cases. In conclusion, PMPC is a useful drug for the long term treatment after prostatectomy.