女子再発性尿路感染症の再発予防に関する研究 --Pipemidic acidの少量・長期間予防投与--

Abstract

成人女性の再発性UTI患者に対して, PPA 1回250 mgを1日1回, 就寝前排尿後の内服を長期間継続し, UTIの再発予防効果を検討した.1)対象症例は非複雑性UTI患者48名, 複雑性UTI患者10名であった.予防投与期間中のUTIの年平均再発回数は非複雑性0.15回, 複雑性0.26回で, 治療開始前の年平均再発回数各3.5回と比較して再発頻度が著明に減少しており, 十分な再発予防効果が認められた.2)6ヵ月間の予防投与を終了した症例を2分して, さらに本治療法を継続した27名と薬剤投与を中止した11名における再発率に差を認めなかったことから, 再発予防投与期間は6ヵ月間で一応目的を達せられるものと考えた.3)外尿道口周囲の細菌叢は予防投与期間中はE. coli, Klebsiella sp.らのグラム陰性桿菌の分離頻度が低下する.長期間の予防投与による細菌の耐性化は認められなかった.4)健康成人5名におけるcross over法でPPA 250 mgを就寝時内服の早朝尿の平均尿中濃度は428 μg/mlであり, 本剤250 mgを朝内服の夕刻の尿中濃度と比較して約2倍の高濃度を示した.5)副作用は全症例58名中6名(10.3%), 7件に認められたが, いずれもその程度は軽く副作用のため投与を中止した症例はみられなかった

The prophylactic efficacy of long-term, low-dose antimicrobial treatment in urinary tract infection (UTI) was studied. Fifty-eight female adult patients with a history of at least two recurrent episodes of UTI in the past year were entered into this study, and the prophylactic regimen was not started until the existing UTI had been eradicated. Patients took 250 mg of pipemidic acid (PPA) daily at bedtime after voiding for 6 consecutive months. Incidence of recurrence of UTI in 48 patients with uncomplicated UTI and 10 patients with complicated UTI decreased to 0.15 and 0.29 per year, respectively, during the treatment compared with 3.5 per year before the treatment. At the end of the 6 months of prophylactic treatment, the patients were divided into two groups by the envelope method. Seventeen patients were treated for a further 6 months and 11 patients were followed up without further medication. Prophylactic efficacy of UTI was obtained in both groups, and there was no significant difference in the incidence of recurrence between the two groups. These findings suggest that the 6-month period of prophylaxis might be sufficient. Examination of the periurethral swab showed that E. coli and Klebsiella sp. were decreased during the treatment. This prophylactic treatment produced no resistant strains. Urinary levels of PPA in the morning urine of patients administered 250 mg of PPA at bedtime averaged 513 micrograms/ml. These values were about 2 times higher than those found in the evening urine after administration of the same dose in the morning.