淋菌性感染症の疫学的・治療学的研究Sultamicillinによる検討

Abstract

1)札幌における淋菌感染症例192例, 女子13例では若年層の頻度が高く, 10歳代症例が男子の13.5%, 女子の30.8%で, 本州のそれぞれ6.1%, 6.3%より高率であった.2)感染源は, いわゆる特殊浴場が31.8%に達したが, 本州の50%より低かった.3)友人, pick up friendの占める率が46.9%で, 本州の19.9%より高い.4)分離淋菌のPPNG分離率は13.8%であった.SultamicllipのMIC (106CFU/ml)はβ-lactamase非産生株で0.05～0.39 μg/ml, 産生株で0.20～1.56 μg/mlに分布した.5) Sultamicillinによる治療は1日750 mg (2錠)でも, 1, 125 mg (3錠)でも有効率にはほとんど差がなかった.副作用にも差が出ていない.3日間治療による淋菌消失率(有効率)は男子で96.2%(著効率38.9%), 女子で83.3%(著効率8.3%)であった.7日間治療によっても, 男子症例31%に漿性分泌物残存があり, Chlamydiaなどの混合感染の可能性も考慮し他剤併用を必要とする

We conducted an epidemiological study including analyses of background factors of 192 male and 13 female patients with gonorrheal infection in the Sapporo area and at the same time, investigated the therapeutic efficacy of sultamicillin, an ester linked prodrug of ampicillin and beta-lactamase inhibitor sulbactam in the treatment of these patients. The percentage of infections in Sapporo was rather high in the young generation, being as high as 13.5% in teen-age boys and 30.8% in teen-age girls, which were higher than the 6.1% and 6.3% of corresponding groups in Honshu island. The source of infections was so-called special public bath-ouse which accounted for about 31.8% of all cases which however, was lower than the 50% in Honshu island. By contrast, the percentage of their friends or so-called pick-up friends as a source of infection in Sapporo was as high as 46.9% which was significantly higher than the 19.9% in Honshu. Juveniles who had nonprostitutes of the other sex as a source of infection are a characteristic of the patients in Sapporo. The isolation rate of PPNG was 13.8%. The MIC (10(6) CFU/ml) of sultamicillin ranged from 0.05 to 0.39 micrograms/ml in beta-lactamase non-producing strains and from 0.20 to 1.56 micrograms/ml in beta-lactamase producing strains showing no trend of higher MIC against beta-lactamase producing strains. There was almost no difference in the efficacy of sultamicillin between a daily dose of 750 mg (2 tablets) and 1125 mg (3 tablets) nor in side effects. The eradication rate (efficacy rate) of gonococcus following a 3-day therapy was 96.2% (38.9% excellent cure rate) in male patients and 83.3% (8.3%) in female patients. In 31% of the male patients who underwent a 7-day therapy, residual serous secretion was found though some inaccuracy is involved in this data since dropouts were not counted. This suggests the need of concurrent therapy with other appropriate drugs in consideration of possible mixed infection involving Chlamydia trachomatis or other microorganisms.