慢性前立腺炎の治療学的研究

Abstract

慢性前立腺炎症例に対し新pyridone carboxylic acid系薬剤AT-2266の治療検討および慢性前立腺炎の病態分析を行なった.前立腺液中に白血球30以上/400倍視野以上の97例を対象とし, その71%に淋菌性又は非淋菌性尿道炎の既往があった.前立腺液の細菌培養で44.1%にGPCを分離した.直前治療のない症例中56.0%に尿道又は排尿関連刺激症状を認め, 他は不定愁訴のみであった.AT-2266 600 mg(分3) 14日間投与の治療効果は, 直前治療のなかった未治療群と治療のあるもので, 7日間治療の有効率はそれぞれ有効以上32.7%, 36.0%であり, 14日間治療ではそれぞれ54.3%, 56.5%であった.尿道及び排尿関連刺激症状の改善はかなり見られるが, 更に7日間の治療により改善度は増加した.関連不定愁訴の改善は良好でなく, 前立腺内白血球の改善率も著しくはなかった.副作用は軽度のものが投与例の1.8%に見られた

AT-2266 is a new antibiotic of the pyridone carboxylic acid class which possesses a broad, low-MIC antibacterial spectrum. Therapeutic studies were carried out on the use of this drug in the treatment of chronic prostatitis, and at the same time a pathological analysis was performed on chronic prostatitis. The subjects were 97 chronic prostatitis patients for whom the prostate fluid had been confirmed to contain at least 30 leukocytes per 400-power magnification field. An analysis of the background factors revealed that 71% of these patients had a past history of gonorrheal or non-gonorrheal urethritis. Culture of the prostate fluid yielded gram-positive cocci (S. epidermidis in most cases) in 44.1% of the patients. E. coli was detected in 3.2% of the patients, while the remaining cases gave negative cultures. In 53.9% of the patients who had not been receiving therapy prior to inclusion in this study, the subjective symptoms consisted of urethral irritation or irritation upon urination. In the other patients, the relationship of the complaints to the disease could not be clearly established. In the patients who had been receiving therapy, the majority did not complain of subjective symptoms. AT-2266 was administered in a daily dosage of 600 mg (in 3 divided doses) for 14 days. The therapeutic efficacy was evaluated. At the end of 7 days of AT-2266 therapy, 15.5% of the previously-untreated group and 8% of the previously-treated group were "excellent" cases, and the efficacy rate was 32.8% and 36%, respectively, when the "good" cases were also included. At the end of the full 14 days of therapy, the corresponding efficacy rates were 21.7% and 17.4%, and 54.3% and 56.5%. Considerable improvement was achieved in the subjective symptoms of urethral irritation and irritation upon urination at the end of 7 days of therapy, and the improvement was even greater following the next 7 days of treatment. With regard to the complaints for which the relationship to the disease could not be clearly established, however, the improvement was not very good: there was not much difference between the results on the 7th and 14th days, and the elimination rate even after 14 days was slightly below 30%. In the previously-untreated patients, improvement in leukocyte count in the prostate fluid to 10 or fewer cells per microscopic field was achieved in 15.6% at 7 days and 21.7% at 14 days. As side effects of AT-2266, mild symptoms were observed to occur in only 1.8% of the patients.