淋菌感染症の疫学的・治療学的研究 - Norfloxacinによる検討 -

Abstract

札幌市における淋菌感染症120例について, 症例の疫学的検討を行なうとともに, NFLXの淋菌感染症に対する基礎的, 臨床的検討を行った.年齢分布は男女とも20代前半にピークを認めた.感染源は男子では10代はガールフレンド, pick-upなどの素人が70.6%を占め, 女子では配偶者が50%, 患者自身が特殊浴場従業女子であるものが50%であった.NFLXのN. gonorrhoeaeに対するMIC分布は, 0.025 μg/mlにピークをもち, 0.0125～3.13 μg/mlに分布した.penicillinase producing Neisseria gonorrhoeae (PPNG)は症例より分離したN. gonorrhoeae 104株中21株(20.2%)であったが, これらのNFLXに対するMICは18株(85.7%)が0.1 μg/ml以下に, 3株(14.3%)が1.56～3.13 μg/mlに分布した.NFLX 200 mg経口投与後の血清中濃度は投与2時間後に平均0.72 μg/mlとピークに達し, 尿道分泌中濃度は投与1時間後に平均0.5 μg/mlとピークに達した.NFLX 600 mg, 7日間経口投与による淋菌感染症に対する治療成績は, 男子尿道炎における有効率が3日間投与で97.4%, 7日間投与で93.1%であり, 女子子宮頸管炎における有効率は3日間, 7日間投与とも100%であり, 本剤は淋菌感染症と対する化学療法剤として高い有効性が認められた.淋菌感染症におけるChlamydia trachomatid (C. trachomatis)感染の合併は, 男子尿道炎で32.7%, 女子子宮頸管炎で20%であり, これらの症例においてはNFLXによる治療後も陰性例よりも分泌物の残存率が高く, 引き続きC. trachomatisに対する化学療法が必要と考えられた.NFLX投与による副作用は全く認められず, NFLXは安全に投与できる薬剤と考えられた

We studied the basic and clinical effects of norfloxacin (NFLX) in 120 patients with gonococcal infections (110 men with urethritis and 10 women with cervicitis)--all residents at Sapporo City; and epidemiologically analyzed the sources of their infections. The male patients were between 16 and 67 years old and the female patients were between 20 and 61 years old, with a peak in the early 20s both for sexes. 70.6% of the male patients in their 10s were infected from their girl friends or so-called pick-up friends and 50% of the female patients from their husbands. The other half of the female were workers serving at so-called special massage parlors. The minimum inhibitory concentration (MIC) of NFLX against N. gonorrhoeae distributed was 0.0125 approximately 3.13 micrograms/ml, with a peak at 0.025 micrograms/ml. NFLX inhibited 93.3% of the clinical strains of this species at less than 0.1 microgram/ml and 96.2% at less than 1 microgram/ml, where the inoculation was 10(6) CFU/ml. Twenty one (20.2%) of the 104 N. gonorrhoeae strains were penicillinase-producing one (PPNG). NFLX inhibited 18 of these PPNG (85.7%) at less than 0.1 microgram/ml and the other 3 strains at 1.56 approximately 3.13 micrograms/ml. Oral administration of 200 mg NFLX showed the average peak serum level of 0.72 micrograms/microliter in 2 hours and the average peak level in the urethral secretions of 0.5 micrograms/ml in one hour. These two concentrations of NFLX covered 95.2% of the MIC distribution against N. gonorrhoeae. The clinical efficacy of 600 mg NFLX (peros) was 97.4 and 93.1% for a 3-and 7-day treatment for male urethritis; and 100% for both 3-and 7-day treatment for female cervicitis. Complicated urethritis with C. trachomatis was noticed in 32.7% of the male urethritis and in 20% of the female cervicitis cases. Urethral secretions among about half of these patients were observed even after treatment with NFLX. As a subsequent treatment, another effective chemotherapeutic is required against C. trachomatis. No adverse reactions were detected with NFLX. All the above results demonstrate that NFLX is a highly effective and safe chemotherapeutic agent for treatment of gonorrhoea.